Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 59 appraisals
Biomedical physics & engineering express
NurtureNest: an IoT-wearable predictive analytics framework for real-time maternal risk assessment
Pregnancy-related complications are increasing globally, necessitating timely and accurate risk prediction for effective clinical intervention. This paper presents NurtureNest, an internet of things-enabled machine learning framework for automated pregnancy risk assessment. The system integrates wearable sensor data from smartwatches with user-provided clinical parameters via a mobile application, enabling continuous remote monitoring. Historical clinical data are used to train multiple machine learning models for multi-class classification of pregnancy risk into low-, medium-, and high-risk categories. Ensemble learning techniques are independently trained and evaluated alongside conventional machine learning classifiers to assess their effectiveness in pregnancy risk prediction. Experimental results show that LightGBM achieves the highest performance with 92.86% test accuracy and 95.04% cross-validation accuracy. Model performance is validated using ROC analysis and feature importance evaluation. The proposed framework enables early risk detection and supports timely clinical decision-making, improving maternal healthcare outcomes.
17 July 2026
Read appraisal →International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics
Integrated artificial intelligence and omics for prediction and monitoring of pre-eclampsia
Pre-eclampsia is a difficult pregnancy condition that causes high blood pressure and can lead to health complications in both mother and newborn, resulting in a higher fatality rate. It presents with a wide range of symptoms and lacks specific indicators, as the contemporary diagnostic techniques, including proteinuria testing and blood pressure measurements, are not reliable. The current evolution in artificial intelligence (AI) technology tends to show a promising transformation of pre-eclampsia management. AI algorithms are applied to process larger sets of clinical, biochemical, and image data that facilitate timely medical interventions by bringing up the early-onset and severity of pre-eclampsia. By analyzing the red cell distribution width (blood test indicators for pre-eclampsia), it is recognized as a cost-effective way of detecting inflammation. The application of AI technology on non-invasive diagnostic (wearable) devices enables continuous monitoring with imaging techniques for the placenta and retina via cloud-based systems. These developments are not only applied for early detection of pre-eclampsia, but also assist decision making capabilities in both high- and low-resource environments. This article explains how the growing use of AI is changing the way that pre-eclampsia is understood and managed, with the aim of improving accuracy and offering more personalized care for pregnant women.
1 July 2026
Read appraisal →Biomedical physics & engineering express
Transformer imputation in CTG: a length-dependent evaluation of reconstruction methods
Objective.Computer and artificial intelligence (AI) analyses are being increasingly used in intrapartum cardiotocography (CTG). However, fetal heart rate (FHR) signal loss, which frequently occurs in clinical practice, hinders visual interpretation and reduces accuracy. Although the impact is well recognized, there is no consensus on the maximum continuous gap length that can be reliably reconstructed under clinical conditions. Therefore, we aim to identify suitable imputation methods and clarify the clinical limits of valid missing-segment lengths.Methods.Using an open FHR dataset (CTU-UHB), we extracted continuous segments and artificially introduced Removed data of varying lengths. Using performance metrics such as difference and similarity, we compared the performance among a Transformer-based model and linear and spline interpolation. Additionally, we quantified the similarity between the Pre-impute and removed data to assess task difficulty.Results.We analyzed 2727 segments from 552 cases across multiple gap lengths. In terms of numerical accuracy root mean square error (RMSE), spline consistently performed significantly worse than others. The Transformer generally maintained a better mean accuracy than linear interpolation, although significant differences were observed only under specific conditions. Conversely, for waveform preservation (correlation), the Transformer consistently outperformed linear interpolation. Notably, in highly complex imputation tasks, the Transformer proved most robust, yielding the lowest RMSE and highest correlation. However, performance systematically degraded for all methods as gap lengths increased.Conclusion.The Transformer provides an effective baseline for FHR imputation under clinical conditions, achieving a favorable balance between waveform and numerical accuracy. By clarifying the clinical limits of valid missing-segment lengths-specifically the decline in reliability beyond 30 s-this study provides guidance for standardizing preprocessing in future CTG AI research and clinical implementation.Significance.For imputing intrapartum FHR data, the Transformer generally improves waveform reproducibility over linear interpolation for short-to-moderate gaps. Defining the reliability limit provides a crucial baseline for future CTG AI.
29 June 2026
Read appraisal →Placenta
Deep learning-based early prediction of gestational diabetes mellitus through first-trimester placental texture analysis
INTRODUCTION: This study aimed to develop a multi-parameter fusion model for early GDM risk prediction and validate its performance through external multicenter testing. METHODS: A total of 628 pregnant women at 11+0-13+6 weeks were enrolled from two medical centers. The Center I cohort was divided into training (n = 356) and testing sets (n = 153). Radiomic features (1,289) and deep learning features (2,048) were extracted from placental ultrasound images. Feature-level fusion resulted in 3337 features, which were selected using Spearman correlation, mRMR, and LASSO. Five models were built: Rad Model, DTL Model, DLR Model, Clinic Model, and Combined Model. Performance was assessed using ROC analysis, DCA, and calibration curves. RESULTS: The Combined Model achieved the best overall performance, with an area under the ROC curve (AUC) of 0.879 in the internal validation, significantly outperforming any single-modality model (P < 0.05). DCA demonstrated that the fusion-based model provided higher net clinical benefit across a wide range of threshold probabilities compared with both "treat-all" and "treat-none" strategies. The calibration curve showed excellent agreement between predicted and observed probabilities (Hosmer-Lemeshow test, P > 0.05). DISCUSSION: The multimodal fusion model enhanced early GDM prediction by detecting subtle placental changes in first-trimester, enabling timely intervention and personalized decision-making.
27 June 2026
Read appraisal →Medical science monitor : international medical journal of experimental and clinical research
Development and Validation of Machine-Learning-Based Prediction Models for Thyroid Diseases During Pregnancy
BACKGROUND International guidelines recommend early screening based on targeted risk factors to identify thyroid disease during pregnancy. The complexity of these risk factors makes accurate prediction challenging. This study aimed to develop and compare multiple machine-learning-based predictive models for thyroid disease during pregnancy. MATERIAL AND METHODS This retrospective study analyzed the clinical characteristics of 5461 women who gave birth at a single center. The dataset was divided into training and test sets. In the training set, feature variables associated with thyroid disease during pregnancy were selected using the Boruta algorithm. Eight models were developed: logistic regression, Bayesian approach, k-nearest neighbors, support vector machine, neural network, classification and regression tree, extreme gradient boosting, and random forest (RF). Model performance was evaluated using the receiver operating characteristic (ROC) curve, precision-recall curve (PRC), calibration curve, and decision curve analysis. RESULTS Nine feature variables were identified: age, height, pre-pregnancy weight, gravidity, parity, primiparity or multiparity, hypertensive disorders of pregnancy, scarred uterus, and autoimmune disease. The RF model demonstrated the best performance, with accuracy of 0.98387819 and 0.99597990, Matthews correlation coefficient of 0.96794139 and 0.97781292, log loss of 0.12670703 and 0.09442025, Brier score of 0.02495798 and 0.01921069, area under the ROC curve of 0.99877170 and 0.99991140, and area under the PRC of 0.99864486 and 0.99922572 in the training and test sets, respectively. CONCLUSIONS The RF model demonstrates excellent discriminative performance, accuracy, consistency, and generalizability in predicting thyroid disease during pregnancy.
23 June 2026
Read appraisal →Environmental research
Air pollution and adverse birth outcomes: A systematic review of fine critical windows
Epidemiological studies have reported associations between prenatal exposure to outdoor air pollution and adverse pregnancy outcomes. However, most analyses assessed exposure over the entire pregnancy or by trimester, potentially missing specific critical windows of vulnerability that recent statistical methods can identify. The objective of this study was to summarise studies examining critical windows of exposure to outdoor air pollution in relation to adverse pregnancy outcomes. This systematic review (PROSPERO-CRD42024523345) followed PRISMA recommendations using PubMed, Embase and CENTRAL databases. The search was performed on April 2024 and udpated on February 2025. Eligible studies analysed critical windows of association between air pollutants (PM2.5, PM10, NO2, O3) and the following outcomes: prematurity, low birth weight, intrahepatic cholestasis of pregnancy, gestational diabetes, pre-eclampsia, eclampsia, gestational hypertension and stillbirth. Two independent reviewers screened titles, abstracts and full texts. Results were synthesised narratively. Out of 3631 articles, 20 studies were included. All were conducted in China or the United States and relied almost exclusively on distributed lag models (DLM or DLNM). Heterogeneity was observed across pathologies and between studies addressing the same outcome. The most consistent finding concerned preterm birth, for which the end of the second trimester (weeks 17-28) was often identified as a critical window. No studies addressed intrahepatic cholestasis of pregnancy or stillbirth. Conclusions. The variability in results reflects distinct pathophysiological mechanisms, differences in exposure levels, or individual characteristics. Precisely identifying critical windows of environmental exposure during pregnancy appears essential to improve perinatal environmental prevention and guide public health action.
15 June 2026
Read appraisal →Journal of tropical pediatrics
A randomized controlled trial to evaluate the efficacy and safety of a double-walled incubator compared to a radiant warmer in the care of extremely low-birth-weight infants
This study compared the safety and efficacy of double-walled incubators versus radiant warmers in extremely low-birth weight (ELBW: birth weight < 1000 g) preterm infants, hypothesizing that incubator care would reduce the time to regain birth weight compared with radiant warmer care. In this single-center, nonblinded, randomized controlled trial, ELBW infants with gestational age ≥25 to ≤32 weeks were randomized shortly after birth to stay in either an incubator or a radiant warmer for the first week of life, followed by radiant warmer care for all infants. The primary outcome was time to regain birth weight. Secondary outcomes included fluid intake, sodium levels, hypernatremia, and other neonatal outcomes. One hundred ELBW infants were enrolled. The median time to regain birth weight did not significantly differ between the incubator and radiant warmer groups: 12.00 (IQR 7.00, 17.75) days versus 11.50 (IQR 7.25, 15.75) days, respectively, with an effect size of median difference 0.0 (95% CI -4.0 to 4.0, P = .89). There were no significant differences in any other secondary outcomes. The study lacked sufficient power to detect differences in these outcomes. Either a double-walled incubator or a radiant warmer can be considered similarly safe and effective for thermoregulation and for achieving time to regain birth weight in ELBW infants. Radiant warmers may be preferable in low- and middle-income countries because they are less costly than double-walled incubators.
12 June 2026
Read appraisal →Placenta
Recent advances in multimodal approaches for investigating placental development and related diseases
The placenta is a vital organ that supports fetal growth and pregnancy maintenance. Its dysfunction is associated with severe complications, including preeclampsia, fetal growth restriction, and placenta accreta spectrum disorders. Traditional approaches to placental research have provided valuable insights but are limited in capturing the complexity of this dynamic organ. In recent years, multimodal approaches-integrating advanced imaging, single-cell and spatial omics, and artificial intelligence (AI)-have enabled comprehensive analyses of placental development and disease. These strategies offer improved diagnostic accuracy, deeper molecular understanding, and real-time assessment of placental function. This review summarizes recent advances in multimodal placental research, highlighting key technologies such as ultrasound and MRI, single-cell transcriptomics, spatial profiling, and AI-based prediction models. Particular emphasis is placed on contributions from Chinese research teams, who have developed novel platforms, atlases, and clinically relevant tools. We also discuss ongoing challenges, including data standardization, interpretability of AI models, and ethical considerations. Looking ahead, the integration of multimodal data with AI and wearable technologies holds promise for precision obstetrics and individualized pregnancy care. Together, these innovations are advancing both scientific understanding and clinical management of placenta-related disorders.
12 June 2026
Read appraisal →Journal of medical Internet research
Text Messaging Support for Patients Diagnosed With Impaired Glucose Tolerance During Pregnancy: Nonrandomized Pre-Post Implementation Study Assessing Impact on Postpartum Transitions of Care
BACKGROUND: Patients with impaired glucose tolerance (IGT) identified during pregnancy who do not develop gestational diabetes mellitus (GDM) often do not receive additional interventions for their long-term metabolic risks. OBJECTIVE: This nonrandomized pre-post implementation study reports the design process and initial program evaluation for Better Follow-up of Impaired Glucose Tolerance (BRIDGE), a 12-week text-based postpartum support program promoting hemoglobin A1c (HbA1c) completion and primary care provider (PCP) visit scheduling for patients diagnosed with IGT during pregnancy, assessing improvement in desired postpartum transition milestones. The 19-month program was divided into 2 arms lasting 9.5 months each, BRIDGE- (SMS text messaging support alone; October 2021-July 2022) and BRIDGE+ (SMS text messaging and IGT-focused postpartum visit; July 2022-April 2023). We aimed to assess whether BRIDGE improved desired postpartum transition milestones. METHODS: Patients were eligible for BRIDGE if they received prenatal care at the study site (a northeastern US academic tertiary care center), were diagnosed with IGT during pregnancy, never developed GDM, and could receive English text messages. We performed a program evaluation using a pre/postimplementation design, comparing outcomes for the BRIDGE population to a 19-month historical population. Primary outcomes were (1) completion of HbA1c testing by 1 year postpartum and (2) PCP visit scheduling by 12 weeks postpartum. A comparative analysis between BRIDGE- and BRIDGE+ was performed. Multivariable logistic regressions controlled for the history of IGT after stepwise backward elimination. RESULTS: In the program evaluation, 503 individuals were included (n=342 in historical population, n=82 in BRIDGE- population, and n=79 in BRIDGE+ population), with similar demographic and clinical characteristics across populations. A total of 212 individuals were screened for eligibility in BRIDGE, and 161 individuals participated in the program. BRIDGE participants had increased odds of HbA1c completion by 1 year postpartum (39.8% vs 12.5%; adjusted odds ratio [aOR] 4.28, 95% CI 2.71-6.78) and PCP visit scheduling (31.0% vs 12.0%; aOR 9.58, 95% CI 4.39-20.9) compared to the historical population. BRIDGE+ patients were more likely to complete HbA1c testing by 12 weeks postpartum than BRIDGE- participants. Most patients attended scheduled PCP visits, but rates of IGT counseling at PCP visits were low. CONCLUSIONS: Individuals with IGT rarely receive targeted interventions during pregnancy or delivery hospitalization. This innovative study demonstrates that individuals with IGT have high rates of uptake for postpartum SMS text messaging support, which tripled completion rates of HbA1c screening within 1 year postpartum and doubled the scheduling rate for PCP visits by 12 weeks postpartum. While attendance at scheduled PCP visits was very high, <60% of PCP visits included IGT counseling, highlighting key improvement areas in the quality of postpartum transitions to primary care. While a randomized trial is needed to ascertain definitive impact, SMS text messaging support may be an effective tool to improve postpartum transitions of care for this underserved population.
12 June 2026
Read appraisal →Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery
Primary Intracranial High Grade Congenital Glial Lesions (PIHGCL): A systematic review of case reports from 1985 to 2025
BACKGROUND: Among congenital intracranial space-occupying lesions, teratomas, gliomas, and neuroblastomas are more frequently reported. However, primary congenital glioblastoma (cGBM) and congenital anaplastic astrocytoma (cAA) are underrecognized entities. Their detection remains challenging due to nonspecific prenatal findings and limited awareness among pediatricians and obstetric care providers, contributing to delayed diagnosis and worsened outcomes. OBJECTIVE: To summarize the clinical presentations, diagnostic imaging characteristics, reported cases, histopathological features, and neuro-oncological management strategies of primary intracranial high grade congenital glial lesions (PIHGCL). MATERIALS AND METHODS: A comprehensive literature search following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted in 2025 over PubMed and Google Scholar using keywords and Boolean operators, retrieving 35 studies (44 patients) with PIHGCL published 1985 to 2025. Quality assessment was done using Joanna Briggs Institute (JBI) tool. The data was analyzed descriptively as well as analytically to determine survival outcomes in treatment groups. RESULTS: A total of 28 studies (37 patients) discussed cGBM, and 7 studies (7 patients) described the occurrence of cAA. Most of the patients were infants i.e., 65.9% (29), presenting with macrocephaly in 27.7% (10) patients. Most of the lesions were intracerebral, 72.7% (32), lateralized equally to both sides, i.e., 46.5% (20). Surgical excision alone was done in 29.5% (13) patients, surgical excision with adjuvant chemotherapy was given to 43.2% (19) patients, chemotherapy alone in 6.8% (3) patients whereas 20.5% (9) underwent only conservative treatment. Kaplan Meir-analysis revealed a significant difference in survival in patients who received adjuvant treatment along with surgical excision in contrast to other treatment groups (χ2 = 7.83, df = 3, p = 0.05). CONCLUSION: PIHGCL presents during fetal or neonatal period with clinicopathological features distinct from adult and pediatric glioblastomas with distinct genetic etiology. Extent of resection is not a reliable marker of treatment outcomes in PIHGCL due to anatomical and physiological variations at the age of presentations. Adjuvant chemotherapy along with surgical resection results in improved patient survival.
11 June 2026
Read appraisal →PloS one
Effect of digitizing Community Health Information System on the delivery and use of maternal and child health services: Propensity score matching analysis
INTRODUCTION: In 2018, Ethiopia's government digitized its Community Health Information System (eCHIS) to enhance Health Extension Program service delivery. However, the impact of eCHIS on health outcomes remains unclear. This study, therefore, examined the effects of eCHIS on the uptake of maternal and child health services. METHODS: A post-test-only, non-equivalent group household survey design was used, collecting data from July to August 2024 in rural communities with and without eCHIS. A stratified multistage sampling technique was employed to recruit respondents. A sample of 1,728 women of reproductive age (271 in eCHIS and 1,457 in non-eCHIS woredas), 1,118 women with children ages 0-11 months (188 in eCHIS and 930 in non-eCHIS), and 569 women with children ages 12-23 months (301 in eCHIS and 268 in non-eCHIS) were included in this study. Propensity scores were used to match intervention and comparison communities based on women's age, religion, parity, education, household wealth, distance to health facilities, and autonomy. A modified Poisson regression analysis, adjusting for covariates, was conducted to estimate the adjusted prevalence ratios (PR) for maternal and child health outcomes. RESULTS: Modern contraceptive use was 66% in intervention areas versus 56% in comparison areas. Institutional delivery rates were 95% in intervention and 79% in comparison areas. In intervention areas, 94% of children received the first dose of the Pentavalent vaccine compared to 83% in comparison areas, while 85% and 68%, respectively, received the third dose. Adjusted analyses showed that eCHIS intervention areas had statistically significant increases in contraceptive use (13.0 percentage points; PR: 1.25; p-value < 0.01) and institutional deliveries (8.9 percentage points; PR: 1.18; p-value < 0.01) compared to comparison areas. Similarly, the average treatment effect of eCHIS on Pentavalent 1, Pentavalent 3, and full vaccination coverage showed significant increases of 10.3 (PR: 1.13; p-value < 0.01), 13.6 (PR: 1.26; p-value < 0.01), and 14.6 (PR: 1.36; p-value < 0.01) percentage points, respectively. CONCLUSION: This study underscores the transformative potential of eCHIS in improving maternal and child health outcomes in Ethiopia. Sustained investment in digital health systems can help scale effective health care services to rural and underserved communities.
31 May 2026
Read appraisal →Journal of medical Internet research
How Machine Learning Can Help Close Evidence Gaps for Drug Safety in Pregnant Women
Women, especially pregnant women, have historically been excluded from clinical research. In this News and Perspectives article, JMIR Correspondent Michelle Falci reports on how advances in data analytics may help bridge evidence gaps.
29 May 2026
Read appraisal →Journal of medical Internet research
Adaptive Fast-Slow Large Language Model Framework for Multidimensional Classification of Prenatal Ultrasound Reports: Comparative Study
BACKGROUND: Phenotype-driven prenatal diagnosis relies on the precise correlation between ultrasound findings and genetic outcomes; however, this process is hindered by the unstructured nature of clinical ultrasound reports. While large language models (LLMs) hold the potential to address this challenge, their specific application in this domain remains systematically underexplored. OBJECTIVE: To establish an effective LLM implementation framework for the clinical multidimensional classification of prenatal ultrasound reports, we evaluated the open-source DeepSeek-V3.2 family on real-world anomalous reports-covering both factual and subjective categories-while integrating retrieval-augmented generation (RAG) and chain-of-thought (CoT) reasoning. METHODS: From a cohort of 4256 pregnancies, we extracted 254 reports with fetal anomalies. We comprehensively evaluated both the high-speed base model (DeepSeek-V3.2-B) and the reasoning-enhanced model (DeepSeek-V3.2-R) across all 5 classification dimensions, comprising 4 factual extraction tasks-primary classification, standardized terminology, anatomical system, and abnormality count-and 1 subjective severity assessment. We further explicitly evaluated the efficacy of RAG for the subjective tasks. Finally, to validate the clinical utility of this approach, we performed a correlation analysis between the expert-validated multidimensional phenotypic profiles and definitive genetic outcomes derived from amniocentesis. RESULTS: While V3.2-B achieved high efficiency in factual tasks (accuracy and F1-score >90%), it underperformed in subjective severity grading (56.6% accuracy), exhibiting a recall of 0 for minor anomalies. Crucially, while RAG significantly improved both models' performance on internal retrieval datasets (P<.05), this benefit did not generalize to external test datasets (P>.05). In contrast, the V3.2-R model utilizing CoT reasoning achieved superior robustness (86% accuracy and F1-score=0.75) on external data without RAG; notably, introducing RAG to V3.2-R degraded performance to 81%, suggesting potential noise interference. Clinical validation against amniocentesis outcomes confirmed that accurate multidimensional phenotypic profiles significantly stratified pathogenic genetic risks. CONCLUSIONS: The rapid base models are efficient for factual classification, and RAG enhances performance on data similar to the knowledge base, whereas CoT is indispensable for subjective assessment. Within the constraints of our dataset and current retrieval implementation, CoT proved more robust than RAG for subjective assessment. However, this finding is specifically tied to our experimental setup and should not be generalized as a universal conclusion. We recommend clinically adopting this adaptive "fast-slow" LLM framework to efficiently perform the multidimensional classification of prenatal ultrasound anomalies. This privacy-preserving, locally deployable solution provides a scalable path to accelerate phenotype-genotype research and optimize invasive diagnostic decision-making.
29 May 2026
Read appraisal →African journal of reproductive health
A systematic review of pregnancy outcomes and management in polycystic ovary syndrome
Polycystic Ovary Syndrome (PCOS), affects 5-20% of women of reproductive age, it is the leading cause of anovulatory infertility accounting for 70-90% of cases and resulting in lower natural conception rates and a significant contributor to adverse pregnancy outcomes. Following PRISMA 2020 guidelines, this systematic review synthesized evidence from 2014-2025, evaluating the evolving landscape of PCOS pregnancy management. It explores the relationship between PCOS and reproductive outcomes, details specific maternal and perinatal complications, and discusses the latest evidence-based interventions and emerging therapies to improve pregnancy outcomes and the long-term health of both mother and child. The findings revealed that the syndrome's pathophysiology driven by hyperandrogenism, insulin resistance, and obesity significantly increases the risks of early pregnancy loss, gestational diabetes, and pre-eclampsia. There is a paradigm shift toward individualized, multidisciplinary care. Evidence-based strategies highlight the superiority of letrozole for ovulation induction, the metabolic benefits of metformin, and the necessity of nuanced lifestyle interventions over simple weight-loss models. Furthermore, emerging research into immune-metabolic pathways, such as Interleukin-22, suggests novel therapeutic directions. The review concludes that recognizing PCOS as a high-risk obstetric condition and integrating early metabolic screening into standard care are essential to improving maternal and neonatal outcomes. Le syndrome des ovaires polykystiques (SOPK), qui touche 5 à 20 % des femmes en âge de procréer, est la principale cause d'infertilité anovulatoire (70 à 90 % des cas). Il entraîne une diminution des taux de conception naturelle et contribue significativement aux complications de la grossesse. Conformément aux recommandations PRISMA 2020, cette revue systématique a synthétisé les données probantes de 2014 à 2025, évaluant l'évolution de la prise en charge des grossesses chez les femmes atteintes de SOPK. Elle explore la relation entre le SOPK et les issues de la reproduction, détaille les complications maternelles et périnatales spécifiques et présente les interventions fondées sur des données probantes les plus récentes ainsi que les thérapies émergentes visant à améliorer les issues de grossesse et la santé à long terme de la mère et de l'enfant. Les résultats ont révélé que la physiopathologie du syndrome, caractérisée par un hyperandrogénisme, une résistance à l'insuline et une obésité, augmente significativement les risques de fausse couche précoce, de diabète gestationnel et de prééclampsie. On observe un changement de paradigme vers une prise en charge individualisée et multidisciplinaire. Les stratégies fondées sur des données probantes soulignent la supériorité du létrozole pour l'induction de l'ovulation, les bénéfices métaboliques de la metformine et la nécessité d'interventions nuancées sur le mode de vie plutôt que de simples programmes de perte de poids. De plus, les recherches émergentes sur les voies immunométaboliques, telles que l'interleukine-22, suggèrent de nouvelles pistes thérapeutiques. Cette revue conclut que la reconnaissance du SOPK comme une pathologie obstétricale à haut risque et l'intégration d'un dépistage métabolique précoce dans les soins courants sont essentielles pour améliorer les issues maternelles et néonatales.
29 May 2026
Read appraisal →PloS one
Determinants of maternal postnatal care utilization in Bangladesh: A machine learning and SHAP-based analysis of BDHS 2022 data
Postnatal care (PNC) plays a crucial role in minimizing maternal and neonatal morbidity and mortality, but the uptake of services in Bangladesh remains below the recommended level. Although logistic regression has been widely used, it may miss complex nonlinear interactions among social, economic, and healthcare factors. This study contributes to the body of knowledge by using machine learning (ML) to identify the most significant determinants of PNC and to enhance prediction accuracy. We compared logistic regression to several ML models, including Random Forest, XGBoost, CatBoost, Support Vector Machine, AdaBoost, and Gradient Boosting, using nationally representative data from the 2022 Bangladesh Demographic and Health Survey (BDHS) with ADASYN oversampling to correct class imbalance. Among all models, Random Forest achieved the highest AUC (0.9050), closely followed by XGBoost (0.9036) and CatBoost (0.9028), all of which substantially outperformed logistic regression (AUC = 0.8470). SHAP analysis of the Random Forest model indicated that delivery place, husband's occupation, rural residence, wealth index, and media exposure were the most influential predictors of PNC utilization, alongside maternal education, women's occupation, and age-related factors. The results indicate that ML is more effective than classical procedures for revealing latent patterns and making accurate predictions. Policy implications include encouraging facility-based deliveries, improving maternal education, reducing wealth disparities, and enhancing media coverage of health, particularly among rural and low-income groups. This paper not only identifies key drivers of PNC in Bangladesh but also demonstrates how ML can supplement traditional methods to reinforce maternal health policy and interventions.
28 May 2026
Read appraisal →The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians
Integrated cell-free DNA and omics genetic scores for early detection of gestational diabetes: evidence from a nationwide multicenter study
BACKGROUND: Gestational diabetes mellitus (GDM) affects 15.6% of pregnancies globally, with Vietnam exhibiting one of the highest prevalences at 21%. Current diagnostic approaches at 24-28 weeks limit early intervention opportunities. We developed a multi-modal machine learning framework integrating cell-free DNA (cfDNA) structural features and genetic information for early GDM prediction at 10-12 weeks of gestation in Vietnamese women. METHODS: We analyzed blood samples from 1,086 pregnant women (435 GDM cases, 651 controls) collected at 9-12 weeks. Two parallel analytical pathways were employed: cfDNA profiling extracting cfDNA-specific features (fragment length, end motifs, GC content, nucleosome patterns), and whole-genome imputation generating predictions for ∼19,000 omics traits. Component scores were developed using TabPFN classifier and integrated via logistic regression into a unified master score. RESULTS: Genome-wide analysis identified five omics traits with significant GDM associations: HSD11B1, NEK7, COMMD10, KLRC4, and OCEL1. Component score optimization revealed distinct patterns-cfDNA scores peaked at 200 features (AUC = 71.53), while genetics-based scores improved with up to 2,000 omics traits (AUC = 77.21). The final master score, integrating three components (gbSC2000, gbSCBH, cfSC200), achieved AUCs of 86.82-87.19 across validation cohorts with 70% sensitivity and 89% specificity. Addition-deletion analysis confirmed that both cfDNA and genetic components provided essential, non-redundant contributions. CONCLUSIONS: This multi-modal framework demonstrates superior performance compared to single-biomarker approaches, enabling risk stratification from very low (4% GDM prevalence) to very high risk (90% prevalence). At the cutoff 0.4, the model identifies 78% of future GDM cases at 10-12 weeks while maintaining an 18% false-positive rate, potentially enabling early interventions to prevent GDM development and associated complications.
27 May 2026
Read appraisal →Journal of perinatal medicine
Functional neurobehaviour of the human fetus: a comprehensive framework for prenatal assessment using 4D ultrasound and AI
OBJECTIVES: To evaluate current evidence on prenatal neurobehavioural assessment using four-dimensional ultrasound (4D-US), structured scoring systems, and emerging artificial intelligence (AI) platforms, and to develop an integrated framework for early identification of neurodevelopmental vulnerability. METHODS: A narrative review of the literature from 2000 to 2025 was conducted following PRISMA-guided organisational principles to enhance transparency. Studies were eligible if they used 3D/4D ultrasound to assess fetal neurobehaviour, including spontaneous motor activity, facial expressions, or behavioural transitions. Specific tools examined included the Kurjak Antenatal Neurodevelopmental Test (KANET), prenatal General Movements Assessment (GMA), and AI-assisted behavioural analysis systems. Methodological quality was appraised using the Newcastle-Ottawa Scale and the Joanna Briggs Institute checklist. Data extraction focused on imaging protocols, behavioural parameters, scoring systems, and associations with neonatal neurological outcomes. RESULTS: Fifty eligible studies demonstrated that fetal motor sequences, movement variability, and facial expressions exhibit hierarchical maturation consistent with developmental progression of brainstem, subcortical, and cortical neural circuits. KANET parameters showed reproducible scoring and meaningful correlation with neonatal neurodevelopment, particularly in high-risk pregnancies. Prenatal general movement patterns displayed continuity with postnatal repertoires and contributed to early neurological prediction. AI-based classifiers provided objective quantification of fetal movement and facial activity, supporting automated or semi-automated assessment workflows. CONCLUSIONS: Functional neurobehavioural assessment using 4D-US, structured scoring tools, and AI-enhanced analysis is feasible, reproducible, and clinically informative. Integrating behavioural markers with neurosonographic findings and computational modelling may strengthen early detection of neurological risk and improve long-term neurodevelopmental care pathways.
27 May 2026
Read appraisal →Zeitschrift fur Naturforschung. C, Journal of biosciences
Exploring the potency of 6-bromo-3-methylquinoline analogues as prostaglandin F2α inhibitors
Prostaglandin F2α (PGF2α) is associated with preterm labor and preterm birth. PGF2α inhibitors have thus proven to be a promising target in the development of lead compounds to prevent preterm birth. In this work, Quantitative Structural Activity Relationship (QSAR) was implemented on a dataset of 77 compounds of 6-bromo-3-methylquinoline analogues using statistical approach and random selection in the QSARINS software. The Genetic Algorithm-Multiple Linear Regression (GA-MLR) approach was used to predict the best model (R 2 = 0.8943 and Q 2 LOO = 0.8836). The inclusion of descriptors FNSA-2 and WV.mass resulted in a well-fitted and highly predictable model. Artificial neural network (ANN) analysis was also carried out to validate the model effectiveness. Twenty eight new molecules with better predicted biological activity (pIC50) were designed. The binding energy from the docking study of seven compounds have shown higher binding activity than P10 into prostaglandin F synthase protein (PDB ID: 2F38). The stability of protein-ligand complex was further validated by 100 ns molecular dynamics simulation and MM-PBSA binding free energy. DFT and ADME-toxicity analysis also confirmed their drug-likeness properties. Collectively, our findings highlight novel quinoline derivatives as promising lead candidates, warranting further validation through collaborative in vitro and in vivo studies.
27 May 2026
Read appraisal →Journal of perinatal medicine
Effect of preterm birth on neonatal, infant, child, young adult and adult mortality: a systematic review and meta-analysis
OBJECTIVES: Preterm birth is associated with a higher risk of mortality. In 2020, the global incidence of preterm births was reported at 9.9 per 100 live births. This meta-analysis was undertaken to evaluate the effect of preterm birth on mortality among various age groups. METHODS: A thorough search was done on four electronic databases: "PubMed, Scopus, Web of Science, and Embase". Adhering to PRISMA 2020 guidelines, observational analytical studies published till 4th December 2024 were included. Screening of the studies was done by two independent reviewers in two stages: title/abstract, followed by full text review of the advanced articles. It was followed by data extraction. Study quality was assessed with the Newcastle Ottawa Scale. Meta-analysis using a random-effects model was done in R Studio. PROSPERO ID: CRD42024622282. RESULTS: Database search yielded 1775 unique studies. 23 studies met the final predefined eligibility criteria. Preterm babies showed an increased risk of mortality compared to term babies with a pooled relative risk of 6.12 (95 % CI: 3.16-11.84) for neonatal mortality, 11.84 (95 % CI: 6.88-20.37) for infant mortality and 1.88 (95 % CI: 1.24-2.83) for 1-5 year. However, it was similar in adult mortality with a pooled relative risk of 1.21 (95 % CI: 0.07-20.12). CONCLUSIONS: Preterm birth is strongly associated with increased risks of childhood mortality, especially in extreme and very preterm infants, but the risk persists even for late preterms.
27 May 2026
Read appraisal →Journal of perinatal medicine
Oral adjuvants supplemented to phototherapy as a therapeutic strategy for neonatal hyperbilirubinemia: a systematic review
INTRODUCTION: Neonatal jaundice is a common condition characterized by elevated serum bilirubin levels. Although usually benign, inadequate management may result in severe complications such as bilirubin encephalopathy and kernicterus. Phototherapy is the standard treatment; however, concerns regarding potential short- and long-term adverse effects have motivated the investigation of oral adjuvants as complementary therapies to accelerate bilirubin clearance and reduce phototherapy exposure. CONTENT: This systematic review followed PRISMA guidelines and was registered in PROSPERO (CRD420251071886). Randomized controlled trials published between 2010 and 2025 were included, evaluating full-term neonates (35-42 weeks, 2-4 kg) without Rh incompatibility. Searches were conducted in PubMed, Cochrane Central, Embase, and Web of Science. Of 193 identified records, 18 RCTs met eligibility criteria. The oral adjuvants assessed included probiotics, phenobarbital, ursodeoxycholic acid (UDCA), oral calcium, zinc sulfate, fenofibrate, and clofibrate. Lactobacillus reuteri demonstrated greater 24-hour reductions in total serum bilirubin (TSB) compared to controls, whereas Bifidobacterium strains primarily reduced phototherapy duration. Phenobarbital did not outperform phototherapy alone and was associated with longer hospitalization. UDCA showed substantial bilirubin reductions, although findings were heterogeneous. Zinc supplementation did not demonstrate consistent significant benefit. Fenofibrate produced statistically significant decreases in TSB across trials and showed the most consistent efficacy. Clofibrate also reduced bilirubin levels but with methodological variability and limited comparative data. SUMMARY: Oral adjuvants combined with phototherapy may enhance bilirubin reduction in term neonates, particularly fenofibrate. OUTLOOK: However, heterogeneity and potential bias limit definitive conclusions, emphasizing the need for large, multicenter randomized trials.
27 May 2026
Read appraisal →Journal of perinatal medicine
Plant-based antioxidant strategies with potential for preeclampsia prevention: clinical and mechanistic insights
BACKGROUND: Preeclampsia is a leading cause of maternal and perinatal morbidity and mortality, driven by oxidative stress, endothelial dysfunction, and systemic inflammation. Current preventive strategies, such as low-dose aspirin, offer modest benefit, highlighting the need for alternative approaches. Medicinal plants with antioxidant and anti-inflammatory properties, long used in maternal health traditions, may provide biological pathways relevant to preeclampsia prevention. SUMMARY: This review synthesizes human clinical and mechanistic evidence on four medicinal plants with documented antioxidant activity - Curcuma longa, Moringa oleifera, Orthosiphon aristatus, and Centella asiatica. These botanicals demonstrate potential mechanisms of action including redox modulation, preservation of endothelial function, and suppression of pro-inflammatory pathways, all of which are implicated in preeclampsia pathophysiology. CONTENT: A PRISMA-guided systematic search of PubMed, Scopus, Web of Science, and the Cochrane Library (2000-2025) identified human studies evaluating these plants' effects on oxidative stress and vascular health. Evidence was synthesized narratively due to heterogeneous study designs and outcomes. Most studies were small, often not pregnancy-specific, and used non-standardized botanical formulations. OUTLOOK: These medicinal plants offer biologically plausible pathways to reduce preeclampsia risk. However, pregnancy-focused randomized trials, dose optimization, pharmacokinetic profiling, and safety evaluations are essential before clinical integration into maternal care.
26 May 2026
Read appraisal →The Cochrane database of systematic reviews
Early erythropoiesis-stimulating agents in preterm or low-birthweight infants
RATIONALE: Preterm and low-birthweight infants are at risk of anemia due to a variety of factors, including low levels of erythropoietin. They may therefore benefit from erythropoiesis-stimulating agents (ESAs). However, controversy remains about their effectiveness and safety, not only in reducing blood transfusions but also in improving clinical outcomes. OBJECTIVES: To assess the benefits and harms of early administration of ESAs in preterm or low-birthweight infants. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, Scopus, DOAJ, and trial registries to 31 March 2025, and checked the reference lists of studies and systematic reviews for potentially relevant studies. ELIGIBILITY CRITERIA: Randomized controlled trials (RCTs) comparing early (initiated before eight days of life) ESAs (erythropoietin or darbepoetin) to placebo or no intervention among preterm (< 37 weeks' gestation) or low-birthweight (< 2500 g) infants. OUTCOMES: Outcomes included mortality during initial hospital stay (all-cause mortality), moderate to severe neurodevelopmental impairment (NDI) at 18 to 26 months' corrected age, proportion of infants exposed to one or more red blood cell (RBC) transfusions, retinopathy of prematurity (ROP), necrotizing enterocolitis (NEC), and severe intraventricular hemorrhage (sIVH). RISK OF BIAS: We used the Cochrane RoB 1 tool to assess risk of bias. SYNTHESIS METHODS: We performed data collection and analyses according to the methods of Cochrane Neonatal (fixed-effect meta-analysis using the inverse-variance method). We analyzed categorical data using risk ratio (RR) and continuous data using mean difference (MD), and reported the 95% confidence interval (CI) on all estimates. We used GRADE to assess the certainty of evidence. INCLUDED STUDIES: We included 37 studies (n = 6724), five (n = 3052) of which are new. Two studies (n = 752) investigated darbepoetin, and 35 studies (n = 5972) investigated erythropoietin. SYNTHESIS OF RESULTS: ESAs compared to placebo or no intervention Mortality: ESAs probably result in little to no difference in mortality during initial hospital stay (RR 0.93, 95% CI 0.80 to 1.09; I² = 0%; 24 studies, 5217 participants; moderate-certainty evidence). Subgroup analysis suggests that early use of erythropoietin probably results in little to no difference in mortality (RR 0.91, 95% CI 0.77 to 1.09; I² = 0%; 23 studies, 4505 participants), and early use of darbepoetin probably results in little to no difference in mortality (RR 1.00, 95% CI 0.71 to 1.43; I² = 0%; 2 studies, 712 participants). NDI: ESAs may reduce moderate to severe NDI at 18 to 26 months' corrected age (RR 0.81, 95% CI 0.68 to 0.95; I² = 86%; 3 studies, 1707 participants; low-certainty evidence). Subgroup analysis suggests that early use of erythropoietin may reduce moderate to severe NDI at 18 to 26 months' corrected age (RR 0.79, 95% CI 0.66 to 0.95; I² = 93%; 2 studies, 1239 participants), while early use of darbepoetin may result in little to no difference in moderate to severe NDI at 18 to 26 months' corrected age (RR 0.87, 95% CI 0.59 to 1.28; I² not applicable; 1 study, 468 participants). Transfusions: ESAs may reduce the proportion of infants exposed to one or more RBC transfusions (RR 0.79, 95% CI 0.76 to 0.83; I² = 56%; 21 studies, 3507 participants; low-certainty evidence). Subgroup analysis suggests that erythropoietin may reduce the proportion of infants exposed to one or more RBC transfusions (RR 0.80, 95% CI 0.76 to 0.84; I² = 56%; 20 studies, 2795 participants); darbepoetin may reduce the proportion of infants exposed to one or more RBC transfusions (RR 0.75, 95% CI 0.68 to 0.84; I² = 0%; 2 studies, 712 participants). ROP (any stage): ESAs result in little to no difference in incidence of ROP (RR 0.91, 95% CI 0.83 to 1.00; I² = 0%; 14 studies, 3844 participants; high-certainty evidence). Subgroup analysis suggests the use of either erythropoietin (RR 0.92, 95% CI 0.84 to 1.02; I² = 0%; 13 studies, 3230 participants) or darbepoetin (RR 0.83, 95% CI 0.58 to 1.17; I² = 0%; 2 studies, 614 participants) results in little to no difference in incidence of ROP. NEC (any stage): ESAs probably reduce the incidence of NEC (RR 0.74, 95% CI 0.62 to 0.87; I² = 0%; 20 studies, 5749 participants; moderate-certainty evidence). Subgroup analysis suggests that early use of erythropoietin probably reduces the incidence of NEC (RR 0.72, 95% CI 0.61 to 0.85; I² = 0%; 19 studies, 5041 participants), while early use of darbepoetin probably results in little to no difference in incidence of NEC (RR 1.08, 95% CI 0.54 to 2.15; I² = 0%; 2 studies, 708 participants). sIVH (grade ≥ 3): ESAs probably reduce the incidence of sIVH (RR 0.70, 95% CI 0.56 to 0.89; I² = 43%; 9 studies, 2458 participants; moderate-certainty evidence). Subgroup analysis suggests that early use of erythropoietin probably reduces the incidence of sIVH (RR 0.72, 95% CI 0.57 to 0.91; I² = 47%; 9 studies, 2396 participants), while early use of darbepoetin probably results in little to no difference in incidence of sIVH (RR 0.40, 95% CI 0.11 to 1.41; I² not applicable; 1 study, 62 participants). Of note, the test for subgroup differences between erythropoietin and darbepoetin revealed no evidence of a difference for the outcomes of mortality, moderate to severe NDI, NEC, sIVH, ROP, and the proportion of infants exposed to RBC transfusion. We downgraded the certainty of evidence for inconsistency, imprecision, and high risk of bias in the included studies. AUTHORS' CONCLUSIONS: Early use of ESAs probably results in little to no difference in mortality (moderate-certainty evidence); may reduce moderate to severe NDI at 18 to 26 months' corrected age (low-certainty evidence); has little to no effect on ROP (high-certainty evidence); may reduce the proportion of infants exposed to one or more RBC transfusions (low-certainty evidence); and probably reduces both NEC and sIVH (moderate-certainty evidence). Given the benefits of ESAs, future research should focus on cost-effectiveness, equity, feasibility of implementation, and acceptability to different stakeholders of the routine use of erythropoietin or darbepoetin among preterm or low-birthweight infants. FUNDING: No funding was received for this review. REGISTRATION: Protocol (and previous versions) available via 10.1002/14651858.CD004863; 10.1002/14651858.CD004863.pub2; 10.1002/14651858.CD004863.pub3; 10.1002/14651858.CD004863.pub4; 10.1002/14651858.cd004863.pub5; 10.1002/14651858.CD004863.pub6.
25 May 2026
Read appraisal →JMIR research protocols
Protocol for Monitoring Postpartum Hypertension Outcomes via a Smartphone App (MOMitor): Ecological Momentary Assessment
BACKGROUND: Postpartum hypertension defined as elevated blood pressure after childbirth, affects approximately 20% of women after delivery. Digital health interventions that include remote monitoring therefore, present an important opportunity to facilitate regular blood pressure assessment in this high-risk population. OBJECTIVE: The primary objective is to assess within- and between-person changes in hypertension status over the first 6 weeks postpartum using a smartphone-based ecological momentary assessment protocol. The secondary objective is to characterize the trajectory of hypertension indicators across the 6-week period and to compare hypertension screening results from week one and week six within participants. METHODS: This study uses a time-series design using data from prospectively enrolled patients within a large health system. Patients eligible for recruitment were women aged 18 years or older who spoke English, owned a smartphone, had a liveborn neonate, and were willing to download an app and respond to survey questions within the app. Throughout the study period, all participants received hypertension screening items that asked whether their blood pressure was greater than 140/90 mm Hg and whether they felt dizzy or lightheaded, short of breath, or had a severe headache. A subset of participants were additionally asked to report their blood pressure readings. We estimate within- and between-participant effects using a generalized linear mixed model for a positive hypertension screen during weeks one through six. The model includes both fixed and random effects, controlling for age, race, marital status, education, insurance status, mode of delivery, total number of pregnancies, and history of diabetes mellitus. RESULTS: The study was funded July 2021 and data collection was initiated in November 2021. Data collection for this study, per protocol, was completed in June 2025, though other participants continue to be enrolled in the ongoing parent study. Data analysis is expected to be completed by Spring 2026 with publication planned for Summer 2026. CONCLUSIONS: The study findings will provide insight into trajectories of hypertension outcomes in postpartum women and the utility for smartphone app-based remote blood pressure monitoring among postpartum women whose blood pressure was regularly tracked. Findings will provide evidence to support whether widespread implementation of this digital health surveillance approach to improve outcomes in maternal health, especially in the postpartum period, is clinically warranted.
23 May 2026
Read appraisal →The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians
Integrated metabolic and inflammatory biomarkers for early association and prediction of adverse pregnancy outcomes: a multicenter validation study
BACKGROUND: Adverse pregnancy outcomes (APOs) affect long-term maternal and offspring health. Conventional metabolic markers, including the triglyceride-glucose (TyG) index, inadequately capture pregnancy-related immuno-inflammatory dysregulation. We propose a composite index, TyNIR, integrating metabolic and inflammatory parameters, and assess its associations with APOs and predictive performance using machine learning. METHODS: Data were collected from two tertiary centers in Fujian, China (2023-2025), including 1,741 pregnancies and an external validation cohort of 300. Early-pregnancy parameters were used to derive TyNIR. Primary outcomes were gestational diabetes mellitus (GDM), gestational hypertension (GH), preterm birth (PB), low birth weight (LBW), and premature rupture of membranes (PROM). Multivariable regression, subgroup, and interaction analyses assessed associations between TyNIR and APOs. A feature selection approach developed the PREMIER model, which was compared with TyG and other models and externally validated. RESULTS: TyNIR was positively associated with GDM, GH, and PB. After adjustment, the highest quartile showed increased risks, with odds ratios (ORs) of 3.86 (95% CI 2.33-6.39) for GDM, 3.05 (1.74-5.36) for GH, and 3.45 (1.24-9.66) for PB. No associations were observed for LBW or PROM. The PREMIER model achieved area under the curve (AUC) values of 0.710 ± 0.031, 0.736 ± 0.040, and 0.742 ± 0.073, outperforming TyG and other models. External validation confirmed consistent associations and superior predictive performance. CONCLUSIONS: TyNIR consistently predicts risks of GDM, GH, and PB. The TyNIR-based PREMIER model shows robust predictive performance with external validation. These findings support early identification of high-risk pregnancies and may guide personalized management of APOs.
22 May 2026
Read appraisal →Revista do Instituto de Medicina Tropical de Sao Paulo
Treatment of brucellosis in pregnant women: a systematic review and analysis of current gaps and future perspectives
Human brucellosis is a globally prevalent bacterial disease with significant implications during pregnancy due to obstetric complications. Despite the importance of early diagnosis and treatment, the lack of therapeutic consensus and robust evidence underscores the need for systematic evaluation to guide clinical practice. This study systematically reviewed the literature to identify and summarize available drug therapy options for brucellosis in pregnant women, focusing on efficacy, safety, and obstetric outcomes. The review followed PRISMA and Cochrane Handbook guidelines. Searches were conducted in MEDLINE, Embase, Cochrane Library, LILACS, and gray literature for references indexed up to September 15, 2025. Eligible studies reported therapeutic interventions in pregnant women with brucellosis. Risk of bias was assessed using the JBI Critical Appraisal tool, and data on participants, interventions, and outcomes were extracted. Of 737 records screened, six studies met the inclusion criteria, comprising retrospective and prospective reports published between 1991 and 2020, totaling 403 pregnant women. Therapeutic regimens varied, with sulfamethoxazole-trimethoprim (SMX-TMP) plus rifampicin being the most frequently used combination. Adverse obstetric outcomes associated with this regimen occurred in 16% (95%CI: 8%-30%) of cases. Overall, abortion occurred in 94 (23.3%) women, 20 preterm births were reported, and 10 newborns had low birth weight. Recurrence was observed in only 3% of cases. Heterogeneity in outcomes and definitions limited comparability. In conclusion, there is no standardized treatment for brucellosis during pregnancy. Adverse obstetric outcomes remain frequent, highlighting the need for controlled studies to establish safe and effective therapeutic protocols.
20 May 2026
Read appraisal →Acta dermato-venereologica
Pregnancy in Women with Atopic Dermatitis: A Systematic Review of Concerns and Challenges
Atopic dermatitis (AD) has negative individual and societal implications. However, the potential impact of ADatopic dermatitis on reproduction has only been sporadically investigated. We aimed to provide an overview of pregnancy in ADatopic dermatitis, with a specific focus on concerns, challenges, the number of children, and adverse pregnancy and birth outcomes. A systematic literature search was performed using EMBASE and PubMed up until 19th January 2026 for original articles in relation to reproduction in female ADatopic dermatitis. Twenty-four highly heterogeneous studies were included. Concerns about ADatopic dermatitis in relation to pregnancy and family planning were reported in >50% of the patients in three3 out of four4 studies. Conflicting results were seen regarding fertility and disease severity during pregnancy. Pregnancy rates were similar or increased based on two2 studies. Eleven studies addressed adverse pregnancy and birth outcomes, of which five5 studies unanimously reported a protective or indifferent effect of ADatopic dermatitis on pre-term birth, gestational diabetes and stillbirth. Outcomes such as gestational hypertension, preeclampsia and miscarriage showed divergent results. Overall, ADatopic dermatitis causes considerable worries in relation to family planning. However, this review implies, that pregnancy rates as well as complications in pregnancy and during childbirth in women with ADatopic dermatitis overall are consistent with women without ADatopic dermatitis.
20 May 2026
Read appraisal →Environmental monitoring and assessment
Air pollution-related health impacts from domestic waste burning and associated interventions: the merits of a traditional versus machine learning scoping review methodology
Regularly updating repositories of air pollution impacts on health is essential for evidence-based policies, interventions, and progress monitoring. However, this is often time-consuming and labour-intensive. Automation can ensure up-to-date evidence; reduce retrieval, screening time, and costs; and make information accessible to non-academic stakeholders. This study investigated whether a machine learning approach can perform any stages of a traditional scoping review on the health impacts, policies, and interventions related to air pollution due to domestic waste burning. A traditional approach was conducted in parallel with machine learning methods enabling a comparison of the efficiency and quality of the partially automated approach against the manual review. Findings from the two approaches were compared and the final set of included articles were considered for (1) reported impacts of waste burning on health outcomes and (2) recommendations on solutions and interventions to prevent/reduce adverse effects on health from waste burning. We found a range of health impacts associated with waste burning, including low birth weight, hypertensive disorders of pregnancy, adverse respiratory outcomes like asthma and wheeze, cancer risk, and mortality. Few studies proposed solutions or evaluated the effectiveness of interventions. The ML approach showed a tendency towards false positives, which are preferable to false negatives (where relevant papers were excluded). Results showed that the model can conduct initial searches and decisions for the review. However, the articles included in the model should be screened manually for final acceptance. Therefore, we propose a hybrid approach be used until the automated model can be further refined.
19 May 2026
Read appraisal →JMIR medical informatics
Adverse Pregnancy Outcomes in Women With Immune Abnormalities: Machine Learning Model Development and Validation Using First-Trimester Sonographic Features
BACKGROUND: The maintenance and progression of pregnancy rely on immune homeostasis at the maternal-fetal interface. However, pregnancy complicated by autoimmune abnormalities can disrupt this balance and significantly increase the risk of adverse pregnancy outcomes (APOs). OBJECTIVE: This study aimed to (1) develop an interpretable predictive tool for APOs in patients with immune abnormalities and (2) interpret the models using Shapley additive explanations (SHAP) values. METHODS: This study retrospectively analyzed clinical data from 288 patients with autoimmune abnormalities at Yichang Central People's Hospital between 2019 and 2024. Feature selection was performed using both the Boruta algorithm and Least Absolute Shrinkage and Selection Operator regression to identify optimal predictive factors associated with APOs. Nine machine learning models were developed and subsequently underwent a comprehensive comparative evaluation of their predictive performance, leading to the identification of the optimal predictive model. SHAP values were generated to provide interpretable insights into model predictions. RESULTS: A total of 288 patients were included in the study, 124 (43.06%) of whom had APOs. The extreme gradient boosting algorithm was shown to be the optimal model after a comparison of 9 different models utilizing various metrics. The SHAP analysis showed that crown-rump length at 6+0 to 8+6 weeks, the number of other drugs, the number of complications during pregnancy, gestational sac volume at 6+0 to 8+6 weeks, and yolk sac diameter change at 6+0 to 8+6 weeks were the key predictive factors affecting APOs. CONCLUSIONS: The study developed an interpretable predictive tool for APOs in patients with immune abnormalities, which may assist clinicians in making early intervention decisions.
14 May 2026
Read appraisal →Archives of gynecology and obstetrics
Clinical outcomes and practical management implications in rudimentary horn pregnancies: a systematic review and pooled analysis (2010-2025)
PURPOSE: Rudimentary horn pregnancies are rare and carry significant maternal and fetal risks. This study aims to systematically review published cases of rudimentary horn pregnancies describing data about time of diagnosis, time of rupture, and live birth rate (LBR), with exploratory comparisons between communicating (CHP) and non-communicating horn pregnancies (NCHP). METHODS: A PRISMA-guided systematic search of PubMed, MEDLINE, and Cochrane (October 1, 2025) was performed with terms "unicornuate uterus pregnancy" OR "rudimentary horn pregnancy." Case reports, series, and reviews with defined clinical data were included; abstracts and unclear reports were excluded. Three independent reviewers extracted data using a standardized protocol. Descriptive statistics (means, medians, standard deviations, and ranges) and exploratory group comparisons (Fisher's exact test, Mann-Whitney U and Student's t test with p < 0.05 denoting significance) were performed. RESULTS: From 132 articles, 190 cases were included: 27 CHP (14.2%) and 163 NCHP (85.8%). Time of diagnosis was earlier in NCHP (15.9 ± 8.9 weeks) than CHP (22.1 ± 10.0 weeks, p = 0.01). Rupture occurred in 68 cases (35.8%), similarly in CHP (48.1%) and NCHP (33.7%, p = 0.19). Time of rupture was earlier in NCHP (18.7 ± 6.6 weeks) than CHP (23.0 ± 9.2 weeks, p = 0.02). Four cases attempted to continue pregnancy; all resulted in premature rupture. Reported live births were infrequent (11.6%) and more common in published CHP (25.9%) vs. NCHP cases (9.2%; p = 0.02). CONCLUSIONS: This descriptive synthesis indicates uterine horn communication may be associated with later diagnosis/rupture and reported live births were significantly more frequent in published CHP vs. NCHP cases. However, all comparisons are exploratory and must be interpreted with extreme caution, as data limitations preclude causal inference. Exhaustive imaging and diagnosis are essential to characterize horn type. Surgical termination is advised, but if expectant management is chosen, close monitoring and multidisciplinary care, including weekly ultrasounds, are advisable to mitigate complications.
14 May 2026
Read appraisal →BMJ open
Mapping the evidence on stillbirth prevention across the reproductive continuum: an umbrella review
OBJECTIVES: To collate and appraise evidence from existing systematic reviews and meta-analyses on interventions to prevent stillbirth and reduce perinatal mortality across the reproductive continuum, including preconception, antenatal, intrapartum and immediate newborn periods. DESIGN: Umbrella review synthesising evidence from systematic reviews, including meta-analyses where available. DATA SOURCES: A comprehensive search was conducted in CENTRAL (via Cochrane Register of Studies Online), PubMed, Embase and Web of Science, along with trial registries (WHO International Clinical Trials Registry Platform, ClinicalTrials.gov and ISRCTN Registry), from inception to 12 January 2026. ELIGIBILITY CRITERIA: Systematic reviews and meta-analyses synthesising randomised controlled trials or quasi-experimental studies that reported stillbirth, perinatal mortality, fetal loss or fetal death were included. Reviews focused exclusively on predefined high-risk populations were excluded. DATA EXTRACTION AND SYNTHESIS: Two reviewers independently extracted data and assessed methodological quality using A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2). Grading of Recommendations, Assessment, Development and Evaluation (GRADE) certainty ratings were extracted as reported by the original review authors. Evidence synthesis followed a structured framework adapted from Ota et al, integrating direction of effect and certainty of evidence based on pooled estimates and GRADE assessments. Publication overlap was assessed using the Corrected Covered Area index where relevant. RESULTS: A total of 116 systematic reviews were included, synthesising evidence from randomised controlled and quasi-experimental studies across preconception, antenatal, intrapartum and immediate newborn periods. Evidence from individual reviews showed clear benefit for several interventions, including balanced energy-protein supplementation, home visits by community health workers, birth preparedness interventions, labour induction at or beyond 37 weeks of gestation and skilled or community-based intrapartum care, primarily for reducing perinatal mortality. Reduced antenatal visit schedules compared with standard care were associated with a possible increase in stillbirth or perinatal mortality, indicating potential harm. Many interventions-such as group antenatal care (ANC), nutritional education, case-note provision, routine ultrasound or Doppler monitoring, antibiotic treatment for bacterial vaginosis, antiretroviral therapy in pregnancy and several pharmacological or hormonal interventions-demonstrated unknown or inconclusive effects on stillbirth or perinatal mortality, largely due to imprecision and heterogeneity. CONCLUSIONS: This umbrella review identifies a range of interventions with evidence of effectiveness across the reproductive continuum, particularly those addressing maternal nutrition, continuity of ANC and quality intrapartum and newborn care. However, substantial evidence gaps remain, especially for interventions widely implemented without strong supporting evidence. These findings highlight the need for context-specific implementation research and prioritisation of proven strategies in low- and middle-income countries, where the burden of stillbirth remains highest. PROSPERO REGISTRATION NUMBER: CRD42024531100.
14 May 2026
Read appraisal →PloS one
Maternal body mass index and the risk of early-onset Group B Streptococcus disease in newborns: A systematic review and meta-analysis
BACKGROUND: Early-onset group B Streptococcus disease (EOGBS) remains a leading cause of neonatal morbidity and mortality. The incidence can be substantially reduced by intrapartum antibiotic prophylaxis in women with defined risk factors. However, the role of high prepregnancy body mass index (BMI) as a risk factor remains unclear. This systematic review and meta-analysis therefore aimed to evaluate the association between maternal BMI and the risk of EOGBS, as well as related proxy outcomes, including intrapartum vaginal GBS colonization and rectovaginal or urinary GBS colonization before term. METHODS: We systematically searched MEDLINE, Embase, and Cochrane CENTRAL on the 28th of January 2026, for studies examining the relationship between pregestational BMI and EOGBS or its proxy outcomes. Eligible studies included observational and interventional designs but not case reports and conference abstracts. Risk of bias was assessed using the QUIPS tool. Random-effects meta-regression and sensitivity analyses were performed. RESULTS: We identified 19 eligible observational studies reporting data from a total of 3,707,047 women, encompassing 277,887 cases. For the risk of EOGBS and its proxy outcomes, assuming a log-linear association, our meta-regression showed a 2.4% increase in the odds ratio (OR) per unit increase in BMI. This corresponds to an OR of 1.4 (95% CI 1.1-1.6) for a BMI of 35 and 1.7 (95% CI 1.3-2.3) for a BMI of 45, compared to a normal BMI of 22.3. One very large study on 1,971,346 live singleton births with 780 EOGBS cases, found a hazard ratio of 2.4 (95% CI 1.7-3.4) for a BMI of 35.0-39.9 compared to normal BMI (18.5-24.9). CONCLUSIONS: Although the overall association appears modest, incorporating BMI may improve prevention strategies for EOGBS .
13 May 2026
Read appraisal →American journal of epidemiology
Building the mountain mama & baby cohort: study design, protocol, and early prenatal clinic-based recruitment outcomes
Prenatal e-cigarette and cannabis use are increasing. Though concerning, the risks associated with these emerging exposures are unclear due to methodological limitations of available research. To address these gaps, the Mountain Mama & Baby Study prospectively enrolled a cohort of pregnant women in their first trimester during their initial telehealth visit with a nurse navigator at West Virginia University Medicine obstetric clinics. The study's goals were to (1) demonstrate the feasibility of our recruitment methodology and the representativeness of the sample, (2) establish first and third trimester exposure rates and describe the epidemiology of prenatal e-cigarette and cannabis use, and (3) explore associations between prenatal e-cigarette and cannabis exposure and adverse maternal-infant outcomes. This report describes the rationale, study design, protocol, and the feasibility and generalizability of recruitment. We enrolled 417 of 920 eligible participants (45.3%; 95% CI, 42.1% to 48.6%), exceeding our 20% benchmark. Enrolled participants and those nonenrolled were similar across most sociodemographic characteristics (eg, age, race/ethnicity, marital status, rurality, area deprivation). The Mountain Mama & Baby Study will provide clinicians, pregnant women, and public health practitioners with critical information on the potential harms of prenatal e-cigarette and cannabis use, guiding the design of interventions and recommendations.
12 May 2026
Read appraisal →JMIR mHealth and uHealth
Efficacy and Safety of a Telemedicine System in Patients With Gestational Diabetes Mellitus (TELEGLAM): Single-Center, 2-Arm, Randomized, Open-Label, Parallel-Group Study
BACKGROUND: In the management of gestational diabetes mellitus (GDM), the usual medical treatment requires frequent visits for glucose monitoring and insulin dose adjustment, and this imposes significant physical, psychological, and economic burdens on pregnant women. As mobile health platforms become increasingly integrated into diabetes care, telemedicine may help alleviate these burdens; however, evidence evaluating its effectiveness as a replacement for routine in-person GDM care remains limited. OBJECTIVE: This study aims to evaluate the impact of telemedicine on the quality of life and costs for patients with GDM requiring insulin therapy. METHODS: This single-center, 2-arm, randomized, open-label, parallel-group study included patients with GDM who started insulin injection therapy. Participants were randomized to either the telemedicine or standard face-to-face care groups for 10 (SD 2) weeks. The telemedicine intervention used a smartphone-linked platform that enabled the automatic transfer of glucose data from connected glucose meters and facilitated real-time video consultations. Primary end points included costs and patient satisfaction. Costs were assessed using claims data, transportation calculations, and wage-based productivity losses, while patient satisfaction was evaluated through changes in the Problem Areas in Diabetes Survey and Diabetes Therapy-Related Quality of Life questionnaire scores. Secondary outcomes included glycemic control and perinatal outcomes. RESULTS: In total, 38 participants were included, with 18 assigned to the telemedicine group and 20 to the standard care group. Total costs (32,712, 95% CI 15,412-50,013 vs 59,202, 95% CI 42,603-75,800 Japanese yen; $284, 95% CI 134-435 vs $515, 95% CI 370-659, purchasing power parity [PPP]-adjusted; P=.01), direct non-health care costs (922, 95% CI -240 to 2084 vs 2561, 95% CI 1447-3676 yen; $8, 95% CI -2 to 18 vs $22, 95% CI 13 to 32 PPP-adjusted; P=.02), and indirect costs (8981, 95% CI -7119 to 25,082 vs 32,832, 95% CI 17,384-48,279 yen; $78, 95% CI -62 to 218 vs $285, 95% CI 151-420 PPP-adjusted; P=.01) reduced significantly in the telemedicine group compared with the standard care group. The improvements in the Problem Areas in Diabetes Survey (-7.6, 95% CI -13.7 to -1.4; P=.02) and Diabetes Therapy-Related Quality of Life domain 1 (10.5, 95% CI 0.9-20.1; P=.03) scores from the baseline were significantly greater in the telemedicine group than that in the standard care group. Nonetheless, glycemic control and frequency of perinatal complications were comparable between the 2 groups. Consultation time was similar across groups, suggesting no added workload for clinicians. CONCLUSIONS: In this randomized trial, mobile health-enabled telemedicine safely replaced routine in-person visits for patients with GDM requiring insulin therapy. Telemedicine significantly reduced psychological and economic burdens without compromising glycemic or perinatal outcomes, demonstrating its value as a patient-centered and cost-efficient model of care. These findings support the broader implementation of mobile-based telemedicine approaches in GDM management.
12 May 2026
Read appraisal →Journal of Crohn's & colitis
Safety of advanced therapies during pregnancy in women with immune-mediated inflammatory diseases: a systematic review and meta-analysis
BACKGROUND AND AIMS: We aimed to assess the safety of advanced therapies, excluding tumor necrosis factor inhibitors (anti-TNFs), for the treatment of immune-mediated inflammatory diseases (IMIDs), on pregnancy and neonatal outcomes. METHODS AND ANALYSIS: We performed a systematic review and meta-analysis. Study selection and data extraction were conducted independently by two reviewers. Primary outcomes included live births, major congenital malformations (MCMs), miscarriages, and stillbirths. Risk of bias was assessed using ROBINS-I, and the certainty of evidence was evaluated using GRADE. Meta-analyses of prevalence and odds ratios (ORs) comparing advanced therapies with anti-TNFs were conducted using fixed and random effect models. RESULTS: Of 14 661 manuscripts screened, 49 studies met the inclusion criteria: eight cohorts, nine case series, and 32 case reports. Most cohort studies were at a critical risk of bias. The majority of the available data related to ustekinumab (1324 exposed offspring) and vedolizumab (585 exposed offspring) whereas data on other biologics and JAK inhibitors were very limited. Pregnancies exposed to biologics had a pooled prevalence of 82.43% for live births, 0.55% for MCMs, 8.16% for miscarriage, and 0.00% for stillbirths. No significant differences in adverse pregnancy or neonatal outcomes were observed compared with women exposed to anti-TNFs. Overall, the level of evidence was very low, due largely to reliance on small observational studies and case reports. CONCLUSION: Current evidence does not suggest an increased risk of adverse pregnancy or neonatal outcomes with advanced therapies for IMIDs. However, larger, high-quality studies are needed, and these findings should be interpreted as hypothesis-generating.
12 May 2026
Read appraisal →European journal of pediatrics
Post-asphyxia acute kidney injury in neonates: a systematic review
UNLABELLED: Perinatal asphyxia is a major cause of neonatal morbidity and mortality globally. It affects multi-systems and has significant renal consequences. Acute kidney injury (AKI) is a frequent complication of perinatal asphyxia; however, its burden, diagnosis, and outcomes remain variably characterized. This study employed a scoping review approach to map and synthesize the existing evidence on post-asphyxia AKI in neonates. A total of 30 studies published between 1995 and 2025 were included, encompassing different geographic regions, study designs, and diagnostic criteria. The review demonstrates a clear growth in scholarly attention to post-asphyxia AKI, particularly in the last 25 years, coinciding with the introduction of neonatal-modified KDIGO definitions and advances in neonatal nephrology. Reported incidence of AKI varied widely, ranging from 20% to over 60%, reflecting non-homogeneity in study populations, differing case definitions of acute kidney injury in neonates, the severities of hypoxic-ischemic encephalopathy, and varied methodological approaches. Findings consistently indicate that AKI is strongly associated with severe forms of perinatal asphyxia, the presence of multi-organ dysfunction, prolonged neonatal intensive care stay, and mortality. CONCLUSION: Despite emerging interest in novel biomarkers and standard definitions, important gaps persist in early detection, long-term renal outcome data, and evidence from low- and middle-income countries. Addressing these gaps through standardized monitoring, biomarker validation, and longitudinal follow-up will improve renal survival in neonates affected by perinatal asphyxia. WHAT IS KNOWN: • The newborn kidneys are susceptible to the hemodynamic changes that follow ischemia/asphyxia due to a poor functioning capacity and oftentimes an inadequate structural potential. • Neonatal AKI is closely linked to severe forms of asphyxia, increased length of hospital stay and increased mortality. its reported incidence is widely varied. WHAT IS NEW: • The emergence of novel biomarkers in the identification and diagnosis of neonatal AKI, and the uptake and application of standard definitions (modified neonatal KDIGO) in the identification of neonatal AKI. • The availabiltiy of specialized kidney support therapy (continuous kidney replacement therapy; the carpadiem) in the management of neonatal AKI.
11 May 2026
Read appraisal →Molecular omics
Placental metabolomics for assessment of pregnancy complications: a systematic review
Metabolomics is a powerful tool for understanding biological function at the cellular level. While this omics technology has found application in areas ranging from toxicology to cancer, its potential for the study of human pregnancy complications is in its infancy. Proper placental function is critical for a healthy pregnancy and assessing placental metabolism offers a direct window into placental physiology. This review aims to analyse placental metabolomics in pregnancy complications in humans. A systematic search was completed using PubMed and Google Scholar, and the Covidence software was used for the screening process. Following title and abstract screening and full-text review, 32 articles remained and were included in this review. Multiple articles performed metabolomics using mass spectrometry and/or nuclear magnetic resonance to study pre-eclampsia, gestational hypertension, foetal growth restriction, maternal obesity, gestational diabetes mellitus, intrahepatic cholestasis of pregnancy, and preterm birth. A subset of pregnancy complications was investigated in only a single study each (human immunodeficiency virus in pregnancy, neural tube defects, chromosomal disorders, chronic hypoxia, and recurrent pregnancy loss). Univariate analyses identified potential biomarkers of pregnancy complications. Multivariate analyses demonstrated that the placental global metabolic profiles could separate healthy and complicated pregnancies and identified metabolic pathways (e.g. amino acid metabolism, lipid and phospholipid metabolism) to explain pathogenesis and the mechanisms of disease. We highlight knowledge gaps and future directions, emphasizing the need for data replication and inclusion of variables such as biological sex in the field of placental metabolomics.
11 May 2026
Read appraisal →BMJ open
Does previous pregnancy experience improve folic acid supplementation uptake? A systematic review and meta-analysis.
OBJECTIVE: To examine whether multiparous women have more or less folic acid uptake than primiparous women. OUTCOMES: Preconceptional, periconceptional and postconceptional folic acid use among all pregnant women and high risk pregnant women. DESIGN: Systematic review and meta-analysis. DATA SOURCES: MEDLINE-Ovid, CINAHL Ultimate, Scopus and ProQuest Medical. ELIGIBILITY CRITERIA: Observational epidemiological studies comparing folic acid use between primiparous and multiparous women, published in English from January 1994 to June 2024. DATA EXTRACTION AND SYNTHESIS: Two reviewers screened all papers meeting the eligibility criteria. One reviewer completed data extraction and assessed study quality using an adapted version of the Newcastle-Ottawa Scale. Three other reviewers independently assessed 10% of the studies as a quality check. Random-effects (DerSimonian and Laird) meta-analyses combined results for each outcome. Heterogeneity, risk of publication bias and certainty of evidence were assessed. RESULTS: Of the 10 982 records identified, 81 studies involving 826 855 women were included in the review. 27 studies were conducted in Europe, 22 in Asia, 11 in North America, 7 in Africa, 7 in Australia, 5 in the Middle East and 2 in South America. Multiparous women were consistently less likely to take folic acid before and during pregnancy than primiparous women. For preconceptional use, the odds were 29% lower among multiparous women (adjusted OR (aOR): 0.71; 95% CI 0.64 to 0.78; n=25 studies; I2=88.67%), and 58% lower in multiparous high-risk women (aOR: 0.42, 95% CI 0.27 to 0.64; n=3 studies; I2=27.28%). For periconceptional use, the odds were 32% lower among multiparous women (aOR: 0.68; 95% CI 0.63 to 0.74; n=28 studies; I2=85.46%). Postconception, the odds were 21% lower among multiparous women (aOR: 0.79; 95% CI 0.74 to 0.85; n=33 studies; I2=85.91%). By the second trimester, there was no significant difference between the two parity groups (aOR: 0.96; 95% CI 0.87 to 1.05; n=4 studies; I2=0.00%). The certainty of evidence was low for preconceptional, periconceptional and postconceptional uptake due to heterogeneity, and moderate for preconceptional uptake among high-risk women. CONCLUSIONS: Multiparous women were less likely to take folic acid preconceptional, periconceptional and postconceptionally, despite their previous pregnancy experience. Barriers to folic acid supplement uptake among multiparous women need to be identified, and strategies to address them in preconception, antenatal and interconception care should be investigated. PROSPERO REGISTRATION NUMBER: CRD42024553241.
11 May 2026
Read appraisal →Neurosurgical review
The efficacy of ventriculosubgaleal shunt in managing neonatal hydrocephalus due to intraventricular hemorrhage: a systematic review and meta-analysis
Intraventricular hemorrhage (IVH) is a severe complication in premature neonates, occurring in 25%-30% of cases and often leading to posthemorrhagic hydrocephalus (PHH). When blood clots in the cerebrospinal fluid (CSF), preventing permanent shunt placement, temporary interventions are considered. Ventriculosubgaleal shunt (VSGS) utilizes the subgaleal space to absorb and drain excess CSF, reducing infection risk and allowing hydrocephalus control until the neonate reaches an appropriate weight and CSF clarity. This systematic review and meta-analysis evaluate the safety and efficacy of VSGS in treating neonatal PHH. A systematic review was conducted using Medline, Embase, and Web of Science following Cochrane and PRISMA guidelines. Eligible studies included those with ≥ 4 neonates. The primary outcomes analyzed were VSGS-related infection, VSGS revision, VSGS catheter migration, catheter obstruction, VSGS-related CSF leakage, permanent ventriculoperitoneal shunt (VPS) placement, overall mortality, and procedure-related mortality. A total of nineteen studies, encompassing 562 neonates, were included in our analysis. The pooled VSGS-related infection rate was 9% (95%CI: 5% to 12%). The need for VSGS revision was observed in 4% of cases (95%CI: 0% to 8%). The catheter obstruction rate was 2% (95% CI: 0% to 5%), while VSGS catheter migration occurred in 1% of cases (95%CI: 0% to 5%). VSGS-related CSF leakage was reported in 6% of neonates (95%CI: 3% to 9%). Permanent VPS placement was required in 75% of patients (95%CI: 67% to 82%). The overall mortality rate was 10% (95%CI: 4% to 16%), and the procedure-related mortality rate was 1% (95%CI: 0% to 2%). This systematic review and meta-analysis identified VSGS as a safe and effective option for treating hydrocephalus caused by IVH in premature neonates.
10 May 2026
Read appraisal →Journal of neonatal-perinatal medicine
Machine learning demonstrates normal fetal Doppler velocimetry associated with reduced risk of necrotizing enterocolitis among preterm infants with growth restriction
BackgroundNecrotizing enterocolitis (NEC) is an intestinal ischemic disease that affects preterm infants with fetal growth restriction (FGR). The role of fetal Dopplers in stratifying risk for developing NEC is unclear but the innovative use of machine learning technology may aid in identifying their contribution.MethodsThis is a single center retrospective cohort of 164 infants born before 33 weeks' gestation with FGR from 2016 to 2019. We used machine learning to classify NEC and to evaluate the predictive values of gestational age (GA), birth weight (BW), and the presence of abnormal umbilical artery (UA) Dopplers before delivery.ResultsEarly GA and lower BW strongly predicted NEC. The presence of normal fetal UA Dopplers was heavily weighted in classifying infants unlikely to develop NEC. Fetal UA Dopplers had a 95% specificity (15% sensitivity) for NEC.ConclusionsIf validated, normal fetal UA Doppler studies may identify infants with FGR at low risk for NEC who may avoid conservative NEC-prevention strategies.
9 May 2026
Read appraisal →Pediatric radiology
Deep learning based gestational age estimation from multi-view fetal brain magnetic resonance imaging
BACKGROUND: Gestational age (GA) is essential for assessing fetal development, but conventional methods such as last menstrual period and ultrasound are often inaccurate, particularly in late pregnancy. Recent advances in deep learning (DL) and MRI offer more reliable and consistent GA estimation by capturing detailed fetal brain development. OBJECTIVE: This study aimed to develop deep learning models for GA prediction using multi-view fetal brain MRI and to compare their performance with conventional biometric regression techniques. MATERIALS AND METHODS: A total of 1,321 fetal MRI scans were used to train and evaluate various DL models, while an additional 80 publicly available MRI scans served as an external test set. Two training strategies were explored: transfer learning versus training from scratch, and single-view versus multi-modality input. RESULTS: The pre-trained ResNet-101 model achieved a mean absolute error (MAE) of 4.47 days and a coefficient of determination (R2) of 0.96 on the internal test set. On the external test set, the model yielded an MAE of 6.57 days, outperforming the biometric regression method, which achieved an MAE of 9.42 days. Explainability analysis revealed that the model predominantly focused on the lateral ventricles, cerebellum, and surrounding brain regions for GA prediction. CONCLUSIONS: The integration of multi-view MRI and transfer learning significantly enhanced the predictive accuracy of DL models for GA estimation. The proposed approach outperformed conventional biometric regression and highlighted clinically relevant anatomical regions, demonstrating its potential for use in prenatal diagnostic applications.
5 May 2026
Read appraisal →PloS one
Prevalence of perinatal depression in Ethiopia: An umbrella review of systematic review and meta-analysis studies
BACKGROUND: Perinatal depression is a significant public health concern that affects women during pregnancy and the postpartum period. Despite being acknowledged globally, the burden of perinatal depression is particularly profound in low and middle-income countries, such as Ethiopia. This umbrella review is therefore intended to systematically consolidate findings on perinatal depression among Ethiopian women to better understand its prevalence, thereby highlighting the gaps in current research and informing future interventions. METHODS: This umbrella review used the PRIOR checklist for the reviews of systematic review and meta-analytic studies. The review protocol has been registered on PROSPERO: CRD42023495174. PubMed, EMBASE, and PsycINFO databases were searched for the presence of systematic review and meta-analysis studies. The quality of included articles has been evaluated with a measurement tool to assess systematic review and meta-analysis studies (AMSTAR). A novel graphic approach with an estimated corrected covered area (CCA) has been used to determine the degree of overlap of primary studies in the systematic review and meta-analysis studies. The weighted random effect model was used during the meta-analysis. RESULT: A total of 28 unique primary studies and 8 systematic reviews, and meta-analysis studies with 15,592 participants were included in this umbrella review. The pooled prevalence of perinatal depressive symptoms in the included systematic review and meta-analysis studies ranges from 20.1% to 25.8%. The pooled umbrella prevalence of perinatal depressive symptoms among women in Ethiopia was 22.49% (95 CI%:21.38, 23.59). The pooled umbrella analysis revealed that the antenatal and postnatal depressive symptoms were 22.76% (95% CI: 19.9, 25.62) and 21.75% (95% CI: 21.03, 22.48), respectively. In addition, the pooled prevalence of perinatal depression in studies that included 10 or below primary studies is 22.86% (95%CI:20.39, 25.33), and in those that included below 10 primary studies, it was 22.10% (95%CI: 21.55, 22.65). The novel graphic presentation depicted a very high degree of overlap of primary studies in the included systematic reviews and meta-analysis studies; corrected covered area (CCA) of 25.5%. Four of the included studies (fifty percent) had high methodological quality, and the remaining four relied on a moderate quality range. CONCLUSION: The pooled overall, antenatal, and postnatal prevalence of depression symptoms was high in Ethiopia, with no significant difference during the antenatal and postnatal period. An improved understanding of perinatal depression will therefore guide policymakers and health practitioners in developing targeted strategies to alleviate this mental health challenge.
3 May 2026
Read appraisal →Stroke
Preterm Delivery and Long-Term Risk of Maternal Stroke: Systematic Review and Meta-Analysis
BACKGROUND: Adverse pregnancy outcomes are linked to increased risk of maternal cardiovascular disease. However, the association between preterm delivery (PTD) and long-term risk of stroke in the mother remains uncertain, particularly in the case of spontaneous PTD. METHODS: A systematic review and meta-analysis were performed to provide an up-to-date synthesis of the evidence on the association between PTD and long-term maternal stroke. PubMed, CINAHL, and Web of Science were searched for relevant articles published between January 1, 2000, and May 6, 2025. Eligible studies included cohort and case-control studies examining populations of parous women. Primary exposure was defined as any PTD; secondary exposures were spontaneous PTD and medically indicated PTD. The primary outcome was defined as any stroke; secondary outcomes were ischemic and hemorrhagic stroke. Two reviewers screened studies, extracted data, and performed quality assessments. Pooled unadjusted and adjusted effect estimates (as defined by the original study) were calculated separately using random effects inverse variance models. RESULTS: Eleven thousand twenty-five studies were screened for eligibility. Across 21 studies including a total of 8.7 million participants, PTD was consistently associated with increased stroke risk. The follow-up period ranged from 8 to 57 years. The primary meta-analysis demonstrated a positive association between any PTD and any stroke (adjusted risk ratio [aRR], 1.66 [95% CI, 1.34-2.05]). A high level of heterogeneity was observed (I2=97%, τ2=0.15), possibly due to variations in exposure definition, outcome ascertainment, and follow-up durations. Spontaneous PTD (aRR, 1.37 [95% CI, 1.15-1.64]) and medically indicated PTD (aRR, 2.08 [95% CI, 1.70-2.54]) were associated with any stroke. PTD was positively associated with ischemic (aRR, 1.59 [95% CI, 1.45-1.75]) and hemorrhagic stroke (aRR, 1.44 [95% CI, 1.06-1.94]). CONCLUSIONS: Women who have experienced a PTD, including spontaneous PTD, may be at increased risk of stroke in later life. These women may benefit from targeted cardio-metabolic preventive interventions postpartum to reduce their risk.
2 May 2026
Read appraisal →BMJ health & care informatics
i-MoMCARE: AI-enabled mobile app for maternal and child health care in Cambodia - a pilot implementation and evaluation study
OBJECTIVES: In Cambodia, village health support groups (VHSGs) are central to maternal and child health (MCH) service delivery, yet maternal mortality remains high with regional disparities. Although digital health solutions show promise, their real-world use is underexplored. This study therefore aims to evaluate the i-MoMCARE app in supporting VHSGs and health centre staff for delivering MCH services. METHODS: A mixed-methods approach guided by the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework was used. Reach was assessed using programme records (number of users trained and MCH cases managed). Effectiveness and adoption were evaluated using the mHealth App Usability Questionnaire (MAUQ) and qualitative data on user experience and intention to use. Implementation was examined through system usage monitoring and feedback on workflow integration. Maintenance was explored using qualitative insights on long-term use, barriers and recommendations. RESULTS: 44 VHSGs and 10 health centre staff were trained, and 96 MCH cases were managed with the app. Usefulness was rated highly (MAUQ 5.58, SD 1.04), with users appreciating the user-centric design that improved usability and integration into daily workflows. Effectiveness was similarly high (MAUQ 5.50, SD 0.95); the clinical decision support system and point-of-care alerts were valued as reliable decision-support tools, and the electronic medical record (EMR) was seen as a secure data repository. However, adoption was hindered by hardware and software limitations (MAUQ 5.79, SD 0.75), including device availability and low digital literacy. DISCUSSION: Our findings highlight the value of the i-MoMCARE app in supporting VHSGs, particularly those with limited training, by enhancing their decision-making. The study also lays the groundwork for a unified EMR in primary care. However, concerns around hardware and software limitations hinder adoption and sustained use. CONCLUSION: To enable scale-up, we recommend reducing access barriers and supporting sustained use through diversifying the platform's design and implementing phased incentivisation strategies.
27 Apr 2026
Read appraisal →Biomedical physics & engineering express
Impact of multimodal information on the estimation of fetal growth indicators using machine learning regression models
Accurate estimation of fetal growth indicators such as birth weight, birth length, and gestational age at birth is essential for monitoring pregnancy outcomes and guiding clinical decisions. Traditional predictive models typically rely on ultrasound-based fetometric data to estimate fetal weight or length. While valuable, these models provide estimates only at the time of measurement, rather than predicting values at birth, and may overlook important clinical and sociodemographic factors that also influence fetal growth. This study aimed to evaluate whether incorporating echographic, clinical, and sociodemographic features could improve the accuracy of predicting fetal growth indicators at birth and to quantify the contribution of each variable. Data from 154 cases were collected and processed for model development (61.5% for training and 38.5% for testing), divided into three feature sets: fetometric, clinical-sociodemographic, and combined clinical, echographic, and sociodemographic data. Six regression models were developed to predict three fetal growth indicators: birth weight, birth length, and gestational age at birth. Model performances were assessed usingR2, mean absolute error (MAE), and mean absolute percentage error (MAPE). The multimodal models significantly outperformed those relying only on fetometric or clinical-sociodemographic data, with the random forest achieving the best performance for birth weightR2: 0.8991; MAE: 255.08 g; MAPE: 8.46%, birth lengthR2: 0.8679; MAE: 7.21 cm; MAPE: 2.73%, and gestational age at birthR2: 0.8886; MAE: 1.34 d; MAPE: 2.76%. Feature relevance analysis revealed that variables such as maternal height, maternal weight, placenta location, and alcohol consumption played substantial roles in prediction accuracy, alongside classic fetometric measurements such as head circumference. These findings highlight the multifactorial nature of fetal growth and demonstrate that integrating clinical and sociodemographic information enhances the performance of fetal growth prediction models, ultimately supporting improved perinatal care.
25 Apr 2026
Read appraisal →BMC pregnancy and childbirth
Comparative effects of rotational effleurage and connective tissue massage on labor pain, duration, and perineal outcomes in pregnant women: a randomized clinical trial
BACKGROUND: Childbirth is a unique and significant experience in every woman's life. A negative childbirth experience, often due to difficult labor, can adversely affect a mother's feelings toward her baby and their subsequent relationship. Massage, a non-pharmacological pain relief method involving coordinated manipulation of soft tissues by hand, aims to alleviate pain and enhance comfort. This ancient technique is widely used during labor and has demonstrated effectiveness in reducing both the intensity and duration of labor pain. This study aimed to compare the effects of two massage methods-rotational effleurage massage and connective tissue massage (CTM)-on pain intensity and labor outcomes. The study subjects in the two intervention groups received effleurage massage and connective tissue massage, but the control group did not receive any intervention and only routine labor care was provided to them. METHODS: This quasi-experimental, multicenter study was conducted on 90 pregnant women (gestational age 38-40 weeks) admitted in labor at three hospitals. Participants were selected through convenience sampling and randomly allocated into three groups of 30 using permuted block randomization within each center. Although random allocation was performed, due to the multicenter design and non-probability sampling, the study is more accurately classified as quasi-experimental. Written informed consent was obtained from all participants. Data collection tools included a demographic and obstetric questionnaire, the McGill Childbirth Satisfaction Questionnaire, a visual analogue scale for pain, and a labor evaluation checklist. DATA: Statistical analyses were performed using SPSS software version 22 (IBM Corp., Armonk, NY, USA). In this randomized clinical trial, 90 primiparous women were randomly assigned to three groups: effleurage massage, Connective tissue massage, and control. The interventions were performed during the active phase of labor (4-10 cm cervical dilation). Pain intensity was measured using the Visual Analogue Scale at different dilation stages: 3-4 cm, 5-6 cm, 7-8 cm, and 9-10 cm). RESULTS: Pain intensity significantly decreased in both intervention groups compared to the control group at all stages of the active phase of labor (p < 0.001). At 7-8 cm dilation, the mean pain scores were 6.13 ± 0.94 in the effleurage group, 6.23 ± 0.77 in the connective tissue massage group, and 7.87 ± 0.86 in the control group (p < 0.001). Effleurage massage demonstrated greater efficacy than connective tissue massage in reducing pain during the later stages of active labor (p < 0.05). CONCLUSION: Effleurage massage was more effective than connective tissue massage in reducing pain intensity during active labor. Integrating effleurage into maternity care as a non-pharmacological method may improve maternal comfort and support positive birth experiences.
20 Apr 2026
Read appraisal →Archives of disease in childhood. Fetal and neonatal edition
Umbilical cord management strategies and risk of intraventricular haemorrhage in preterm neonates: a systematic review and meta-analysis
OBJECTIVES: To assess the comparative effectiveness of different umbilical cord management strategies for preventing intraventricular haemorrhage (IVH) in preterm neonates. DESIGN: A systematic review and meta-analysis. STUDY SOURCES: PubMed, Scopus and Web of Science were searched from inception to March 2025 for relevant randomised controlled trials. PARTICIPANTS: All preterm neonates born <37+0 weeks of gestation. INTERVENTIONS: All umbilical cord management strategies, including immediate cord clamping (ICC), delayed cord clamping (DCC), intact umbilical cord milking (I-UCM), cut umbilical cord milking (C-UCM), intact cord stabilisation (ICS), physiology-based cord clamping and extrauterine placental perfusion. MAIN OUTCOME MEASURES: Any grade IVH (grades I-IV) and severe IVH (grades III-IV). DATA SYNTHESIS: Random-effects meta-analyses were conducted to calculate risk ratios (RRs) with 95% CIs. Analyses were stratified for very preterm (<32 weeks) and extremely preterm neonates (<28 weeks). RESULTS: Forty-nine studies with 8706 neonates were included. Thirty-five direct comparisons between strategies were made, but no clear evidence of benefit or harm emerged. Certainty of evidence ranged from moderate to very low, often downgraded due to imprecision, risk of bias and inconsistency. The most frequent comparison was DCC versus ICC, with 14 studies (RR 0.90, CI 0.65 to 1.26) for any grade IVH and 11 studies (RR 1.14, CI 0.69 to 1.87) for severe IVH. The second most common comparison, DCC versus I-UCM, showed no benefit: RR 1.03 (CI 0.80 to 1.32; eight studies, 2200 participants) and RR 0.77 (CI 0.35 to 1.66; seven studies, 2032 participants). ICS versus DCC was the only comparison which was rated as moderate certainty of evidence for both, any grade IVH (RR 0.96, CI 0.82 to 1.13) and severe IVH (RR 0.91, CI 0.62 to 1.35). CONCLUSIONS: No umbilical cord management strategy was clearly associated with increased or decreased IVH risk. Evidence certainty was generally low to very low, primarily due to bias and imprecision.
19 Apr 2026
Read appraisal →Archives of disease in childhood. Fetal and neonatal edition
Intermittent hypoxia and caffeine in infants born preterm: the ICAF Randomized Clinical Trial
OBJECTIVE: To determine whether extending caffeine therapy through 43 weeks' postmenstrual age (PMA) decreases intermittent hypoxia (IH) in convalescing preterm infants. Secondary objectives were to assess caffeine effects on changes in inflammation-related plasma biomarkers and brain MRI. DESIGN: Multicentre masked randomised trial. SETTING: 16 US hospitals. PATIENTS: Infants at <30 weeks + 6 days gestational age on caffeine between 32 weeks and 36+5 days PMA in room air with routine caffeine discontinuation prior to 36 weeks +6 days. INTERVENTION: Randomisation to caffeine or placebo and treated through 42 completed weeks. Pulse oximetry was recorded from enrolment through 1 week after stopping study drug. Blood for 12 inflammation-related biomarkers obtained at enrolment and 38 weeks' PMA and brain imaging after enrolment or <3 days of randomisation, and study end. MAIN OUTCOME MEASURE: Seconds/hour of oxygen saturation <90% from randomisation to study end. RESULTS: Randomised 160 subjects, 78 placebo, 82 caffeine. IH was less at every PMA with caffeine treatment from 34 (172.7 (123.4, 241.7); 84.7 (64.4, 111.4, p<0.01) through 41 weeks (73.0 (51.3, 103.7); 26.6 (18.5, 38.2, p<0.001). Adjusted TNF-α levels were 23% lower at follow-up in the caffeine group compared with placebo (p<0.02), without other biomarker differences. Paired brain imaging found no significant differences. CONCLUSIONS: Extended caffeine reduced the burden of IH in very preterm infants and may reduce inflammation. Further study is needed to determine if this effect of caffeine is associated with reduced risk of adverse outcomes. TRIAL REGISTRATION NUMBER: NCT03321734.
19 Apr 2026
Read appraisal →PloS one
Operationalization of Severe Maternal Morbidity surveillance in administrative databases of the Brazilian public and private health systems: Brazil 2015-2022
The study of severe maternal morbidity (SMM) is an important strategy for improving the quality of obstetric care. The objective of this study is to assess SMM cases recorded in the Hospital Information System of the Unified Health System (SIH/SUS), which contains public funded hospitalizations, and in the database of the National Supplementary Health Agency (ANS), which contains hospitalizations paid for by health plans. This is a cross-sectional study using obstetric hospitalizations of women aged 10-49 years from both databases in the period 2015-2022. We assessed SMM cases using the World Health Organization's criteria for potentially life-threatening conditions (PLTC). Of the 26 PLTC criteria, 22 were operationalized through diagnoses during hospitalization, using International Classification of Diseases-10 codes, or medical procedures, using specific codes of each database. We estimated the frequency and odds ratio of death for each isolated criterion, for grouped criteria and for the total number of SMM cases, as well as the frequency of deaths according to the number of SMM criteria. We identified 18,807,757 obstetric hospitalizations in the SIH/SUS and 3,776,986 in the ANS database. The estimated proportion of SMM was 8.51% and 7.30% in SIH/SUS and ANS, respectively. Most cases presented only one criterion. Differences were observed among sectors, with a higher frequency of procedure-based criteria in the ANS database, compatible with the greater availability of resources in private services. The proportion of deaths increased with the increase in the number of criteria, and more severe criteria presented a higher odds ratio of death. The results indicate that it is possible to estimate the number of SMM cases in the country, both in public and private hospitalizations. Continued investment in the quality of recording in both databases are necessary so that the estimates can truly reflect the maternal morbidity of Brazilian women.
18 Apr 2026
Read appraisal →Sleep
Fetal sleep: a cross-species review of physiology, measurement, and classification
STUDY OBJECTIVES: Fetal sleep is a vital yet underexplored aspect of prenatal neurodevelopment. Its cyclic organization reflects the maturation of central neural circuits, and disturbances in these patterns may offer some of the earliest detectable signs of neurological compromise. This is the first review to integrate more than seven decades of research into a unified, cross-species synthesis of fetal sleep. We examine: (1) Physiology and Ontogeny-comparing human fetuses with animal models; and (2) Methodological Evolution-transitioning from invasive neurophysiology to non-invasive monitoring and deep learning frameworks. METHODS: A structured narrative synthesis was guided by a systematic literature search across four databases (PubMed, Scopus, IEEE Xplore, and Google Scholar). From 2925 identified records, 169 studies involving fetal sleep-related physiology, sleep-state classification, or signal-based monitoring were included in this review. RESULTS: Across the 169 studies, fetal sleep states become clearly observable as the brain matures. In fetal sheep and baboons, organized cycling between active and quiet sleep emerges at approximately 80%-90% gestation. In humans, this differentiation occurs later, around 95% gestation, with full maturation reached near term. Despite extensive animal research, no unified, clinically validated framework exists for defining fetal sleep states, limiting translation into routine obstetric practice. CONCLUSIONS: By integrating evidence across species, methodologies, and clinical contexts, this review provides the scientific foundation for developing objective, multimodal, and non-invasive fetal sleep monitoring technologies-tools that may ultimately support earlier detection of neurological compromise and guide timely prenatal intervention.
17 Apr 2026
Read appraisal →Infection and immunity
Maternal influences on oral microbiome development and implications for early childhood health: a systematic review
A deeper understanding of how maternal-infant interactions shape the establishment and diversification of the oral microbiome could have significant clinical applications; however, relatively few studies emphasize early maternal-infant microbial connections. This systematic review provides a longitudinal analysis of oral microbiome development from birth to five years, focusing on the relationship between maternal and infant microbiomes. We conducted a systematic search (June 2025) using keywords "mother," "children," "oral microbiome," and "longitudinal" across PubMed, Cochrane Library, and Embase. Twelve studies fulfilled the inclusion criteria: longitudinal design, healthy mother-child dyads, saliva sample collection, and relevant age range. We excluded review articles, non-English publications, and studies with overlapping data. Results were synthesized by developmental stage and topic. Overall, current literature agrees that the mother is an important source of exposure for initial colonization of the newborn's oral microbiome. Several studies indicated that the oral microbiome at birth is diverse and unspecialized, composed mostly of maternally derived strains. Rapid selection occurs over the first few weeks, as the relative abundances of typical oral bacterial species increase. Throughout the first year, increases in diversity strengthen the resemblance between infant and maternal microbiomes. The microbiome appears to stabilize around 3-5 years. In conclusion, maternal-infant connections play a significant role in influencing oral microbiome development during the first 5 years of life. This review highlights the need for future studies to incorporate larger, longitudinal designs with metadata and advanced tools to clarify the roles of delivery mode, tooth eruption, and parental lifestyle habits in shaping early oral microbiome development.
17 Apr 2026
Read appraisal →Spectrochimica acta. Part A, Molecular and biomolecular spectroscopy
SERS-based deep learning approach for early detection of gestational diabetes mellitus
Early and precise diagnosis of gestational diabetes mellitus (GDM) is crucial for improving maternal and neonatal outcomes and reducing the risk of adverse pregnancy events. However, current clinical screening methods for GDM still exhibit limitations in detection speed, sensitivity and convenience, making it difficult to meet the clinical demand for rapid early-pregnancy screening. To address this, we propose a novel strategy for early GDM diagnosis based on surface-enhanced Raman spectroscopy (SERS) combined with deep learning, aiming to achieve rapid and accurate early screening. Characteristic SERS spectra of serum were obtained using a substrate based on silver nanoparticles (Ag NPs). A fused PCA-CNN model integrating principal component analysis (PCA) for dimensionality reduction and a one-dimensional convolutional neural network (1D-CNN) for feature learning was developed. The PCA-CNN model effectively extracts potential biomarker features from serum SERS spectra, achieving a diagnostic accuracy of 93.7%, with sensitivity and specificity of 0.95 and 0.93, respectively. Moreover, the entire detection process can be completed within 30 min, requires about 2.5 μL of serum per sample, and involves minimal preprocessing, highlighting both efficiency and practicality. This study provides a novel method for early GDM screening that combines high diagnostic performance with clinical applicability, offering promising technical support for early intervention and clinical management of GDM.
16 Apr 2026
Read appraisal →PloS one
Virologic suppression among HIV-positive pregnant and lactating women receiving antiretroviral therapy in Africa: A systematic review and meta-analysis
BACKGROUND: The elimination of mother-to-child transmission of human immunodeficiency virus (HIV) is a key global public health priority. In Africa, virologic failure among people living with HIV continues to pose a significant public health challenge, affecting both individual well-being and community health. Maintaining viral load suppression is crucial to prevent vertical transmission of HIV and to minimize maternal morbidity and mortality. To stop the vertical transmission of HIV and lower the risk of maternal morbidity and mortality, it is important to achieve viral load suppression. Although many African countries have adopted the global 95-95-95 targets, comprehensive data on virologic suppression among pregnant and lactating mothers across the continent remains limited. The objective of this systematic review and meta-analysis was to determine the pooled estimate of virologic suppression and to examine the factors associated with it among HIV-positive pregnant and lactating women on antiretroviral therapy in Africa. METHODS: This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The study protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD420251186121). We carried out a thorough systematic review by examining PubMed, ScienceDirect, Hinari, and Google Scholar for relevant studies. Data from the studies were retrieved using an Excel sheet and analyzed with STATA version 17. The Joanna Briggs Institute appraisal tool was used to evaluate the methodological quality of studies. A random-effects model with restricted maximum likelihood (REML) was applied to determine the pooled prevalence of virologic suppression (viral load threshold ≤1000 copies/ml) among pregnant and lactating mothers in Africa. A funnel plot and the Egger's test were used to investigate publication bias. Statistical heterogeneity was assessed using the I2 statistic and Cochrane's Q test. RESULTS: A total of 55 eligible studies, comprising 304,883 participants, were included in the quantitative meta-analysis. Accordingly, the overall prevalence of virologic suppression among HIV-positive pregnant and breastfeeding women in Africa was 80.86% (95% CI: 77.63%, 84.09%, I2 = 99.84%). In contrast, the pooled estimate for achieving an undetectable viral load was substantially lower, at 60.92% (95% CI: 52.46%, 69.39%; I2 = 99.91%). Virologic suppression was significantly associated with women's age (15-24 years) (AOR = 0.49; 95% CI: 0.32-0.77), disclosure of HIV status to a partner (AOR = 1.66; 95% CI: 1.31-2.11), first-line antiretroviral therapy regimen (AOR = 6.53; 95% CI: 1.93-22.06), and good antiretroviral drug adherence (AOR = 3.61; 95% CI: 1.18-11.02). In addition, other socio-demographic variables, higher educational level, being married/cohabitant, urban residency, healthcare utilization (time of ANC booking, time of ART initiation, duration of ART), fear of stigma, distance to health facility, shortage of health professionals, ART drug stock-out, and lack of HIV care commodities were significantly associated with virologic suppression among HIV-positive pregnant and lactating women in Africa. CONCLUSION: The pooled estimate of virologic suppression among HIV-positive pregnant and breastfeeding women in Africa was approximately 81%, below the global target of 95% virological suppression. This emphasizes the necessity of targeted strategies for younger HIV-positive women, disclosing HIV status, initiating first-line antiretroviral regimens, and promoting antiretroviral treatment adherence. Upgrading health care systems to enable regular viral load monitoring, as well as addressing socio-demographic and antiretroviral therapy-related variables, are vital steps towards attaining and sustaining VS in these groups of population, ultimately assisting in achieving elimination of MTCT of HIV.
14 Apr 2026
Read appraisal →Heart (British Cardiac Society)
Subclinical atherosclerosis in women after pre-eclampsia: a systematic review and meta-analysis
BACKGROUND: Women with pre-eclampsia are at increased risk of later-life cardiovascular disease (CVD). Despite suggestions that women affected by pre-eclampsia should undergo routine CVD screening, uniform recommendations are lacking. Subclinical atherosclerosis provides a window of opportunity to identify and treat those at risk of CVD. Coronary artery calcium scoring (CAC), carotid intima-media thickness (CIMT) and ankle brachial index (ABI) are effective methods of detecting subclinical atherosclerosis. This systematic review sought to explore associations between timing of measurement and presence of subclinical atherosclerosis in women with a history of pre-eclampsia. METHODS: We searched the MEDLINE, EMBASE and CINAHL databases for all studies which reported subclinical atherosclerosis in women with a history of pre-eclampsia. Common and random effects models were used to examine the associations between pre-eclampsia and subclinical atherosclerosis. RESULTS: 35 case-control studies comprising 20 235 women were included in the final analysis. 3376 had a history of pre-eclampsia. Among the 26 studies assessing CIMT, pre-eclampsia was associated with increased CIMT (standardised mean difference 0.63 (95% CI 0.32, 0.93)). This difference was present during pregnancy (0.65 (95% CI 0.33, 0.98)) and persisted for 12 months post partum (0.84 (95% CI 0.20, 1.47)) and beyond (0.50 (95% CI 0.01, 0.99)). Pooled analysis of the eight CAC studies also demonstrated that the odds of having subclinical atherosclerosis were 1.57 (95% CI 1.39, 1.77) times higher in women with a history of pre-eclampsia. CONCLUSIONS: Among women with a history of pre-eclampsia, subclinical atherosclerosis can be seen during pregnancy and persists long term. Our review supports the importance of early follow-up in patients who have had pre-eclampsia.
12 Apr 2026
Read appraisal →PloS one
Risk factors for spontaneous abortion following hepatitis E vaccination during and shortly before pregnancy: Further analysis from a cluster-randomized trial
BACKGROUND: A recent randomized trial of Hepatitis E Vaccine (HEV239) found an elevated risk of spontaneous abortion (SAB) in women given HEV239 during or within ninety days before pregnancy. Here we present additional analyses to better understand this risk. METHODS: We investigated whether maternal risk profiles of SAB or gestational age at SAB differed between women receiving HEV239 versus control Hepatitis B vaccine (HBV). We also assessed whether HEV239-vaccinated women who experienced SABs had distinct short-term adverse reactions compared to HEV239-vaccinated women who had live births, exploring potential inflammatory mechanisms. Finally, we assessed maternal exposure to HEV239 in narrowly defined pre-last menstrual period (LMP) windows to more precisely demarcate pre-LMP at which HEV-239 vaccination was associated with an elevated risk of SAB. Chi-square tests and Mann-Whitney U tests were performed for bivariate comparisons. Poisson models were used for multivariable analyses. FINDINGS: Baseline maternal risk factors for SAB (age, body mass index, parity, and histories of SAB, hypertension, or diabetes) were similar between the SABs in HEV239 and HBV groups. Median gestational age at SAB was comparable (10.5 weeks [IQR 10-13] for HEV239 vs. 11 weeks [IQR 9-12.2] for HBV, p = 0.783). No increased short-term adverse events (pain: 9% vs. 9%; fever: 2% vs. 1%) were observed among HEV239 recipients who experienced SABs compared to those who did not. An elevated risk of SAB was observed in HEV239 recipients vaccinated 31-60 days pre-LMP (Relative Risk 4.3 [95% CI 1.3-19.3], p = 0.026). INTERPRETATION: Our analyses did not uncover associations pointing to a biological mechanism underlying the original observation of an increased SAB rate connected to HEV239 vaccination shortly before or during pregnancy. Targeted studies such as placental examinations and genetic testing are needed to investigate potential mechanisms.
11 Apr 2026
Read appraisal →Journal of psychosomatic obstetrics and gynaecology
The effect of Snyder's hope theory-based psychological intervention on post-traumatic growth in chinese women experiencing perinatal loss: a randomised controlled trial
OBJECTIVE: To evaluate a Snyder's hope theory-based psychological intervention for promoting post-traumatic growth (PTG) in women after perinatal loss. METHODS: This single-blind randomised controlled trial enrolled 140 women (≥20 years) who had experienced perinatal loss. Participants were randomised to an intervention group (n = 70, four weekly hope-based sessions plus routine care) or a control group (n = 70, routine care only). The primary outcome was PTG, with secondary outcomes including grief, hope and post-traumatic stress symptoms. Assessments were conducted at baseline, post intervention and at 1-month follow-up. RESULTS: The intervention group demonstrated significantly greater improvements in PTG than the control group (post intervention: 69.4 ± 10.2 vs 58.3 ± 11.9; follow-up: 71.9 ± 9.6 vs 59.5 ± 11.0; both p < 0.001), with a large effect size (Cohen's d = 1.21). Significant benefits were also observed in grief reduction, hope enhancement and reductions in trauma-related symptoms (all p < 0.001). Regression analysis identified post-intervention hope as a robust predictor of PTG (β = 0.44, p < 0.001). CONCLUSIONS: Snyder's hope theory-based intervention effectively promoted PTG and improved psychological outcomes in women experiencing perinatal loss. This approach represents a promising therapeutic framework for supporting women through the complex process of moving from trauma to growth following perinatal loss.
4 Apr 2026
Read appraisal →BMJ global health
The effects of antenatal interventions on gestational weight gain in low and middle-income countries: a systematic review
BACKGROUND: Gestational weight gain (GWG) during pregnancy is a critical factor that affects maternal and child health outcomes. The considerable burden of inadequate GWG and the rising tide of excessive GWG are overlooked challenges in low and middle-income countries (LMICs). METHODS: This systematic review assessed the impact of antenatal interventions on GWG in LMICs. Randomised controlled trials (RCTs) on antenatal interventions on GWG in LMICs were included. These interventions included educational, behavioural, nutritional supplementation and pharmacological therapies. A systematic literature search was conducted using PubMed, Embase, Web of Science, CINAHL and the Cochrane Library from the start of each database through September 2025. RESULTS: Out of the 33 642 unique articles identified, 70 articles were included in our systematic review, with 59 individual RCTs and 11 cluster RCTs. Nutritional interventions (31 studies) included food and micronutrient supplementations. Micronutrient supplementation such as multiple micronutrient supplementations was found to reduce the risk of severely inadequate or inadequate GWG among pregnant women compared to iron only or iron and folic acid supplementation (Grading of Recommendations Assessment, Development and Evaluation [GRADE]: moderate certainty). Food supplementation showed mixed results, although most trials demonstrated higher mean GWG among undernourished pregnant women and a greater likelihood of achieving Institute of Medicine-recommended ranges (GRADE: moderate certainty). Behavioural (counselling/education) interventions (20 studies) were associated with significant reductions in excessive GWG among pregnant women with overweight or obesity and improved adequacy of GWG (GRADE: moderate certainty). Physical activity (seven studies) was found to reduce the risk of excessive GWG (GRADE: moderate certainty). Combined dietary and physical activity interventions (six studies) were found to reduce the risk of excessive GWG among pregnant women (GRADE: low certainty). CONCLUSIONS: Well-structured antenatal interventions, initiated before 20 weeks of gestation and continuing beyond this period, tailored to local cultural contexts and available resources, can effectively help pregnant women in LMICs in achieving optimal GWG. PROSPERO REGISTRATION NUMBER: CRD42022366354.
4 Apr 2026
Read appraisal →Regional anesthesia and pain medicine
Efficacy and safety of intrathecal adjuvants for perioperative management of cesarean delivery: a systematic review and network meta-analysis of randomized controlled trials
BACKGROUND: Cesarean section (CS) rates have increased globally, necessitating effective anesthesia management. Single-shot spinal anesthesia has limitations due to its duration and the dose-limiting adverse effects of local anesthetics. OBJECTIVES: To evaluate the effectiveness and safety of intrathecal adjuvants combined with local anesthetics in the perioperative management of CS pain. DESIGN: Systematic review with network meta-analysis. DATA SOURCES: PubMed, Cochrane Library for Clinical Trials, and Embase. ELIGIBILITY CRITERIA: We included women undergoing CS under single-shot spinal anesthesia with any intrathecal drug or placebo added to a long-acting local anesthetic. We selected single- or double-blind, parallel-group, randomized controlled trials (RCTs) reported in English. We excluded crossover, non-randomized, up-and-down dose-finding studies and clinical trials comparing the same drugs in all study arms. RESULTS: We included 166 RCTs with 14 925 patients assigned to 32 interventions. Buprenorphine and diamorphine were the highest-ranked treatments for reducing pain intensity at 24 hours, though not statistically significant. Morphine alone or in combination with meperidine, neostigmine, epinephrine, or nalbuphine significantly increased the duration of effective analgesia and reduced opioid consumption. Dexmedetomidine and morphine significantly prolonged the motor block duration. The safety profile of intrathecal adjuvants was generally adequate. CONCLUSIONS: While the strength of evidence, overall, was very low to low, our study suggests that while none of the interventions significantly reduced pain intensity at 24 hours, several significantly prolonged effective analgesia and reduced postoperative opioid consumption. Dexmedetomidine and morphine prolonged the duration of motor block. None of the intrathecal adjuvants evaluated significantly increased the occurrence of severe adverse events. Future large-scale RCTs are essential to provide more robust evidence. PROSPERO REGISTRATION NUMBER: CRD42024479424.
4 Apr 2026
Read appraisal →Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology
Fetal cardiac remodeling in second trimester in pregnancies with pre-eclampsia and/or fetal growth restriction: deep-learning-based approach using population-wide data
OBJECTIVE: Pre-eclampsia (PE) and fetal growth restriction (FGR) have been shown to impact fetal cardiac remodeling in the third trimester and postnatally, with evidence to suggest that this leads to increased long-term cardiovascular risk. This study aimed to examine fetal cardiac remodeling in pregnancies with PE and/or FGR during the second trimester. METHODS: This was a retrospective nationwide cohort study of ultrasound images from routine screening at 18-22 weeks of gestation in Denmark. We included 139 430 singleton pregnancies that were conceived spontaneously for which at least one relevant standardized cardiac plane (four-chamber view and/or three-vessel view) was available from the second-trimester scan. An artificial intelligence model performed automated segmentation and extraction of fetal cardiac biometric measurements. Data were collected for four groups: the reference group, defined as appropriate-for-gestational-age (AGA) fetuses from a normotensive pregnancy (n = 131 150); AGA fetuses from a PE pregnancy (AGA + PE group; n = 3095); FGR fetuses from a normotensive pregnancy (normotensive + FGR group; n = 4572); and FGR fetuses from a PE pregnancy (PE + FGR group; n = 613). Differences between groups in cardiac biometric measurements were presented as Z-scores adjusted for abdominal circumference at the second-trimester scan. RESULTS: Compared with the reference group, fetuses in the PE + AGA group had significantly larger right-sided heart structures, and the main pulmonary artery (MPA) and ventricular septum were wider. Fetuses in the normotensive + FGR group displayed significantly smaller cardiac structures, including smaller MPA and ascending aorta diameters, and increased left ventricular sphericity compared with the reference group. Fetuses in the PE + FGR group differed significantly from the reference group only in terms of smaller left atrial area, narrower ascending aorta and increased left ventricular sphericity. However, PE + FGR fetuses had significantly wider MPA and ventricular septum and larger right-sided structures compared with normotensive + FGR fetuses, mimicking the features of the PE + AGA group, suggesting a distinct effect of PE on fetal cardiac remodeling. CONCLUSIONS: Cardiac remodeling is evident as early as the second trimester, with distinct patterns of modulation in fetuses from pregnancies affected by PE vs FGR. In particular, PE is associated with an enlarged right heart and greater MPA diameter. Understanding these early differences in fetal cardiac morphology may improve risk prediction models and guide early intervention to improve long-term cardiovascular outcome. © 2025 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
4 Apr 2026
Read appraisal →Clin Obstet Gynecol
Artificial Intelligence in Obstetrics: Current Applications, Opportunities, and Clinical Implementation Challenges
Artificial intelligence is transforming obstetric practice through applications in diagnostic imaging, risk prediction, and clinical decision-making. Deep learning algorithms have achieved diagnostic accuracy comparable to that of experienced clinicians. However, gaps persist between algorithmic capability and clinical implementation. Critical challenges include limited external validation and algorithmic bias. This review examines current AI applications in obstetrics across multiple clinical domains: automated fetal biometry, structural anomaly detection, prediction of pregnancy complications, and intrapartum fetal surveillance. It highlights persistent technical, ethical, and implementation barriers. Key recommendations include multicenter validation across diverse populations, explainable AI approaches, and creating strong regulatory frameworks.
1 Mar 2026
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